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HX00062561 


State  Charities  Aid  Association.  New  York 
Committee  on  hospital s«  Few  hos- 
pitals needed  in  greater  New 
York. 


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Columbia  Untoetsitp 
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College  of  ipfjpgtctang  anb  burgeons 

Uttsrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/newhospitalsneedOOstat 


TABLE  OF  CONTENTS 


RECOMMENDATIONS  BY  THE  STANDING  COMMITTEE  ON 
HOSPITALS. 

PAGE 

Reasons  for  submitting  recommendations 7 

Two  parts  of  the  inquiry 8 

I.  Total  number  of  sick  needing  hospital  care 8 

II.  Distribution  and  character  of  hospitals •  g 

The  suggested  scheme  of  hospital  relief  includes g 

1.  Emergency  relief  stations o 

2 .  Local     hospitals g 

3 .  General     hospitals 10 

4.  Convalescent  and  incurable  hospitals 11 

5.  Hospitals  for  tuberculosis  and  other  contagious  diseases n 

6.  Home    treatment 11 

7.  Private  hospitals n 

Special  advantages  of  the  large  general  hospital 12 

Specific  recommendations  in  regard  to  location  of  various  types  of 

hospitals  .  .  .  . 14 

Emergency  Relief  Stations 15 

Local  Hospitals 15 

General  Hospitals 16 

Summary 19 

A  Report  on  Present  Conditions  and  Future  Needs  by  Phil  P.  Jacobs.. .  21 

INTRODUCTION. 

Two  objects  of  investigation;  -  data  on  which  based 21 

CHAPTER  I. 
Hospital  Population. 

Definition  of  hospitals,  etc 22 

Bed  capacity  should  be  larger  than  number  of  patients 23 

Reasons  for  percentage  of  reserve 23 

Opinions  of  superintendents  solicited '. 24 

Hospital     capacity 24 

1 .  Manhattan : 

Present  number  of  beds;  beds  to  be  built 24 

2.  Bronx: 

Present  bed  capacity;  beds  to  be  built 25 

3 .  Brooklyn : 

Present  bed  capacity  largely  centralized;  new  beds/.1.' 25 

4.  Queens 25 

5.  Richmond .'  .\  .  .  . 26 

6.  Summary  of  Hospital  Population. 26 


CHAPTER  II. 

General  Population. 

page 

Necessity  for  studying 27 

1 .  Manhattan 27 

General  increases  and  decreases 27 

Increases  in  density 28 

2.  The  Bronx 29 

3 .  Brooklyn 29 

General  increases  for  25  years.  • 29 

Density. 29 

4.  Queens.  •  • 3° 

5 .  Richmond 3  ° 

6.  Estimate  of  increase  in  population  of  Greater  New  York  to  1920. 
Factors  influencing  estimate 30 

CHAPTER  III. 
Sickness  and  Hospital  Needs. 

Reason  for  considering  sickness 32 

Scarcity  of  data 3  2 

Table  XIV  explained 33 

Total  average  daily  sickness  compared  with  other  results 35 

Percentages  taken  from  Table  XIV 36 

The  hospital  rate 36 

Principle  of  location  of  hospitals 37 

Home  treatment 38 

CHAPTER  IV. 
Conclusions. 

Based  upon  three  preceding  chapters. 39 

I.  Present  needs 39 

1.  Manhattan , 39 

General  excesses  and  lack  of  beds 39 

Methods    of   hospital    distribution 42 

Middle  and  Upper  East  Side 44 

Lower  Manhattan 45 

Reasons  for  hospital  here 45 

Ambulance   station   needed 46 

Middle  West  Side 46 

Ambulance    station  needed 47 

Upper  West  Side 47 

Summary  of  present  needs  of  Manhattan 47 

2.  The  Bronx -. 48 

Present  needs  met 48 

3.  Brooklyn 48 

General  excess  and  lack  in  borough 48 

Heights  and  Red  Hook 48 


s 

3.  Brooklyn — Continued.  page 

North  Brooklyn 49 

New  hospital  of  500  beds  needed 52 

South  Brooklyn 52 

Ambulance   station   needed 53 

East  New  York 53 

Needs  met  by  Bradford  St.  Hospital 53 

4.  Queens 53 

Present  bed  capacity  adequate 53 

5.  Richmond 53 

Present  needs  met 53 

6.  Summary  of  present  needs 53 

II.  Future  Needs 56 

Determining  factors  in  future  needs 56 

Increased  willingness  to  go  to  hospitals 56 

Needs  of  business  sections 57 

General  population  in  1920 57 

Increase  in  hospital  population  to  1920 58 

Three  things  affect  it,  viz. : 

Rate  of  sickness  in  1920 58 

Rate  of  hospital  attendance 58 

Increase  in  general  population 59 

How  far  should  bed  capacity  be  centralized  and  how  far  distributed  59 

Five  factors  summarized 61 

Distribution  of  future  bed  capacity  by  Boroughs 61 

1.  Manhattan: 

Middle  and  Upper  East  Side 62 

Hospitals  enough  in  1920  between  Houston  and  96th  Street 

on  East  Side 62 

Lower  East  Side 62 

Factors  determining  needs 63 

100  beds  needed  in   1920 64 

Middle  West  Side ._ 64 

100  beds  needed  in  addition  to  proposed  station  here 64 

Upper  Harlem 64 

200  beds  to  New  Harlem  Hospital  and  ambulance  station  near 

Audubon    Park 64 

2.  The  Bronx: 

Lower  Bronx,  well  supplied 65 

100  more  beds  and  ambulance  station  willjbe  needed  Jin 

Northern    Bronx 65 

3.  Brooklyn: 

North  Brooklyn 65 

400  beds  needed  in   1920 66 

South  Brooklyn 66 

100  more  beds  in  Borough  Park,  ambulance  station  injBath 

Beach,   and  ambulance  station  in  Waverly 66 


3.  Brooklyn — Continued.  page 

Coney  Island  and  Kings  County  Hospitals  enlarged 66 

Summary  of  Brooklyn  needs 67 

4.  Queens: 

Hospital  in  Newton  and  ambulance  station  in  Woodhaven 

and  Rockaway  Beach 67 

5.  Richmond: 

Will  need  ambulance  station  in  1920 68 

6.  Blackwell's  Island  and  Chronic  Institutions 68 

Reasons  for  omitting  in  previous  discussion 68 

Present  accommodations,  and  plans  for  1920 69 

How  this  capacity  could  be  increased  by  more  centralization  69 

Convalescent  hospital  of  500  beds  needed 69 

Capacity  of  Island  should  be  3,000 70 

7.  Summary  of  future  needs 7° 

CHAPTER  V. 

Summary  and  Table  XIX 71 

Acknowledgment 73 


APPENDICES 


TABLE  I.  Showing  population  of  Manhattan  and  the  Bronx  by 

wards,  1880-190  5 74 

TABLE  II.          Showing  density  of  population  and  death-rate  in  Man- 
hattan, 1905,  by  wards 75 

TABLE  III.        Showing  population  of  Brooklyn,  1 880-1 905,  by  wards.  76 
TABLE  IV.          Showing  population  of  Queens,  1880-190 5,  by  wards,  76 
TABLE  V.           Showing  population  of  Richmond,  1 880-1 905,  by  wards.  76 
TABLE  VI.         Showing  density' of  population  and  death-rate,  Brook- 
lyn, by  wards 78 

TABLE  VII.       Showing  density  of  population  and  death-rate,  Queens, 

by  wards 78 

TABLE  VIII .     Showing  summary  of  population  of  Greater  New  York, 

1880-1905,  by  Boroughs 78 

TABLE  IX.  Showing  hospital  population   of  Manhattan  and  the 

Bronx 79 

TABLE  X.  Showing  hospital  population  of  Brooklyn 81 

TABLE  XI.  Showing  hospital  population  of  Queens 82 

TABLE  XII.        Showing  hospital  population  of  Richmond 82 

TABLE  XIII.     Showing  present  capacity,  proper  bed  capacity,  and 

beds  needed  in  1920,  Greater  New  York 82 

TABLE  XX .       Showing  proposed  additions  in  Manhattan 83 

TABLE  XXI .      Showing  proposed  additions  in  Brooklyn  and  Queens..  8^ 


NEW  HOSPITALS   NEEDED 

IN 

GREATER  NEW  YOR'K. 


Recommendations  Submitted  By  The 
STANDING  COMMITTEE  ON  HOSPITALS 

OF  THE 

STATE  CHARITIES  AID  ASSOCIATION 


To  the  Board  of  Managers  of  the  State  Charities  Aid  Association : 

The  location  and  size  of  municipal  as  well  as  private  hospitals 
in  New  York  City  seems  often  to  have  been  determined  without 
studying  the  requirements  of  different  localities,  and  particularly 
without  formulating  a  general  plan  of  adequate  hospital  accom- 
modations for  the  city  as  a  whole,  so  that  any  new  hospital,  both 
as  to  its  location  and  its  size,  would  form  part  of  a  well-con- 
sidered and  comprehensive  hospital  system. 

It  is  obvious  that  New  York  City,  with  its  4,000,000  of  popu- 
lation should  possess  a  hospital  equipment,  commensurate  with 
its  importance,  both  in  scope  and  scientific  development,  such  as 
obtains  in  many  foreign  cities. 

For  the  purpose  of  submitting  suggestions  to  the  municipal 
authorities  upon  this  subject,  the  Committee  on  Hospitals,  of 
the  State  Charities  Aid  Association,  recently  engaged  a  special 
agent  to  collect  information  in  regard  to  existing  hospital  ac- 
commodations ;  additions,  in  course^  of  erection,  or  definitely 
planned  for ;  and  present  and  prospective  needs  for  additional 
accommodations  so  far  as  could  be  approximately  determined. 
Through  the  kindness  of  several  contributors,  the  Committee 
was  enabled  to  engage  the  services  for  several  months  of  Mr. 
Phil.  P.  Jacobs,  whose  report  in  full  is  appended  hereto.     The 


8 

Committee  does  not  accept  or  endorse  in  all  'particulars  Mr. 
Jacobs'  report,  but  regards  it  as  an  important  and  valuable  con- 
tribution to  the  subject. 

Upon  consideration  of  the  facts  as  presented  in  Mr.  Jacobs' 
report,  and  otherwise  known  to  the  Committee,  and  after  a  series 
of  meetings  at  which  many  different  phases  of  the  subject  have 
been  discussed  at  length,  the  Committee  has  reached  definite 
conclusions  as  to  the  principles  which  should  determine  the  loca- 
tion and  size  of  hospitals  to  be  constructed  hereafter  in  Greater 
New  York.  These  recommendations  deal,  not  with  administrative 
problems,  but  with  questions  of  location,  size  and  function.  It 
is  intended  to  outline  a  general  plan  of  co-ordination  of  hospitals, 
which  would  make  each  of  them  serve  a  definite  purpose  in  a 
well  organized  system;  and  to  suggest  how  the  municipality, 
by  making  from  time  to  time  additions  to  some  existing  hos- 
pitals, and  establishing  a  small  number  of  new  hospitals,  may 
secure  a  well  developed  hospital  system  within  the  next  decade. 

The  inquiry  naturally  divides  itself  into  two  portions : 

i.  As  to  the  total  number  of  patients  requiring  hospital  care. 

2.  As  to  the  distribution  and  character  of  the  hospitals. 

I.  The  fundamental  considerations  determining  the  total  num- 
ber of  patients  are : 

a.  The  prospective  growth  of  population. 

b.  The  amount  and  character  of  sickness  likely  to  occur. 

c.  The  extent  to  which  the  sick  are  likely  to  need  and  to  seek 
hospital  care,  as  distinguished  from  home  care,  or  absence  of 
care. 

AVhile  none  of  these  three  factors  admits  of  exact  calcula- 
tion, sufficient  data  are  available  to  serve  as  a  basis  for  outlining 
a  general  scheme  of  hospital  location  and  distribution,  to  be 
revised  from  time  to  time,  subject  to  modification  as  circum- 
stances may  change,  or  as  later  and  more  specific  data  may 
modify  present  estimates. 

II.  The  fundamental  considerations  affecting"  the  distribution 
and  character  of  hospitals,  assuming  that  general  conclusions 
have  been  reached  as  to  the  total  number  of  patients  to  be  cared 


for,  relate  to  questions  of  environment.  Of  what  size  should 
hospitals  be?  What  should  be  their  exact  location,  classification, 
and  relation  one  to  another?  What  class  or  classes  of  patients 
should  be  received  in  each  ?  There  should  be  stated  at  the  outset, 
the  following  general  principle, — that  a  sick  person  who  is  to 
receive  hospital  care,  should  receive  that  hospital  care  in  his  own 
neighborhood,  if  suitable  surroundings  and  proper  environment 
can  be  had  there,  but  (with  certain  exceptions  noted  hereafter), 
he  should  be  removed  to  some  other  locality,  if  that  step 
be  necessary  in  order  to  secure  environment  favorable  to 
recovery  from  his  particular  disease,  or  facilities  and  equipment 
needed  therefor.  The  application  of  this  principle  will  lead  to 
somewhat  diverse  results  in  the  different  boroughs  of  the  city, 
and  in  different  parts  of  the  same  borough ;  for  instance, — in  the 
upper  portion  of  the  borough  of  Manhattan  there  are  many  open 
spaces  and  attractive  sites  for  neighborhood  hospitals,  where 
land  is  still  comparatively  inexpensive,  but  no  such  sites  are  avail- 
able in  the  lower  densely  crowded  portions  of  the  city. 

The  following  appears  to  be  a  well  co-ordinated  scheme  of 
hospital  relief: 

i.  Emergency  relief  stations.  Relief  stations  with  six  to 
eight  beds  should  be  established  in  districts  which  are  not  at 
present  provided  with  hospitals,  and  the  population  of  which 
does  not  require  at  present  the  establishment  of  a  local  hospital. 
Each  emergency  relief  station  should  be  provided  with  ambu- 
lance service. 

The  Bradford  Street  Hospital,  which  has  been  maintained  for 
some  years  by  the  Charities  Department  in  East  New  York,  with 
a  capacity  of  eight  beds,  is  not  unlike  the  type  of  relief  station 
suggested.  We  assume,  in  this  report,  the  re-organization  of  the 
ambulance  service  in  accordance  with  the  detailed  recommenda- 
tions adopted  by  this  Committee,  and  submitted  December  2, 
1907,  to  the  Commission  on  Hospitals  appointed  by  his  Honor 
the  Mayor. 

2.  Local  Hospitals  having  100  to  200  beds  comprising  mainly 
existing  hospitals,  with  such  additional  hospitals  as  may  be  re- 
quired to  meet  the  needs  of  large  growing  communities,  now 
without  hospital  provision.     Each  of  these  hospitals  should  be 


IO 

provided  with  ambulance  service,  and  should  care  for  such  classes 
of  cases  as  : 

a.  Acute  surgery,  such  as  fractures,  dislocations,  wounds,  ap- 
pendicitis, etc. 

b.  Acute  labor  cases. 

c.  Acute  diseases,  such  as  Bright's  disease,  pneumonia,  hem- 
orrhages, apoplexy,  critical  heart  diseases,  urgent  dyspnoea, 
acute  poisoning,  convulsions,  coma,  delirium,  typhoid  fever, 
acute  rheumatism,   acute   alcoholism,   etc. 

In  addition  to  providing  for  these  classes  of  cases,  there  always 
should  be  a  sufficient  number  of  beds  to  allow  a  10  or  20  per  cent, 
margin  for  catastrophes  and  accidents,  and  also  to  receive  pa- 
tients from  the  neighborhood,  who  perhaps  more  properly  belong 
to  general  hospitals,  hereafter  described,  but  who,  on  account  of 
prejudice,  ignorance,  or  other  causes,  must  first  be  received  into 
a  hospital  in  their  own  neighborhood. 

3.  General  hospitals  having  1,000  to  1,500  beds.  These  hos- 
pitals should  be  located  primarily  with  reference  to  a  favorable 
environment,  and  to  the  possibility  of  securing  a  sufficiently  large 
area  for  the  most  approved  ward  classification  of  patients,  and 
their  distribution  in  a  considerable  number  of  different  buildings, 
with  opportunity  for  outdoor  exercise  for  such  patients  as  need 
it ;  of  isolation  of  various  classes  of  patients  requiring  quiet  or 
unlimited  supply  of  fresh  air,  sunlight,  or  the  psychic  benefits 
of  change  of  scene.  Accessibility  to  large  masses  of  population 
should  be  considered,  but -should  be  subordinated  to  securing  such 
environment  as  would  be  favorable  for  the  best  treatment  of 
patients.  In  these  hospitals  should  be  received  non-acute  cases, 
such  as  anemias,  chronic  heart  and  chronic  lung  diseases  (ex- 
cluding tuberculosis),  chronic  Bright's  disease,  neuritis,  nervous 
prostration,  hysteria,  palsy,  diseases  of  the  stomach  and  intes- 
tines, cancer,  syphilis,  general  operative  surgery,  including  ab- 
dominal surgery,  genito-urinary  surgery,  the  surgery  of  tumors, 
varicose  and  other  ulcers,  etc.  There  should  be  special  wards 
with  every  modern  facility  for  the  treatment- of  diseases  of  the 
eye  and  ear,  nose,  and  throat,  gynecological  cases,  nervous 
diseases,  orthopedic  cases,  mental  diseases,  and  children's 
diseases. 


II 

4.  Convalescent  hospitals  and  hospitals  for  incurables.  These 
may  be  located  in  direct  connection  with  the  general  hospitals 
above  referred  to,  if  these  hospitals  be  suitably  located,  and  if 
sufficient  land  be  available  therefor.  Such  proximity  is  desirable, 
both  for  reasons  of  economy  and  administration  and  also  because 
many  acute  conditions  will  develop  among  incurable  patients  re- 
quiring treatment  in  a  general  hospital.  The  convalescent  hospitals 
should  provide  for  convalescent  typhoid  cases,  rheumatism,  tubercu- 
lar joints,  healed  fractures,  etc.,  and  many  other  types  of  disease 
and  injury.  The  hospitals  for  permanent  diseases  should  provide 
for  inoperable  cancers,  aneurysms,  cirrhosis  of  the  liver,  paralysis, 
locomotor  ataxia,  etc.,  etc. 

5.  Special  hospitals  for  tuberculosis  and  for  the  acute  con- 
tagious diseases.  As  the  location  and  size  of  these  hospitals  are 
determined  by  special  considerations,  and  as  in  many  cases  they 
should  be  located  outside  the  city  limits,  they  are  not  considered 
at  length  in  this  report.  The  Committee  is  of  opinion  that 
tuberculosis  patients  should  be  excluded  from  both  local  and 
general  hospitals  as  rapidly  as  separate  hospitals  for  their  care 
can  be  provided. 

6.  Home  treatment.  Not  all  sick  persons  require  hospital  care, 
and  in  fact  some  patients  may  be  treated  with  better  results  at 
home.  In  view  of  the  fact  that  public  outdoor  relief  is  prohibited 
by  the  charter  of  this  city,  the  municipality  cannot  undertake 
direct  assistance  of  the  sick  poor  in  their  homes.  We  are  of  the 
opinion,  however,  that  a  closer  co-ordination  of  the  hospitals, 
public  and  private,  with  the  philanthropic  agencies  that  assist  the 
poor  in  their  homes,  would  be  effective  in  securing  hospital  care 
for  a  larger  proportion  of  those  who  really  need  hospital  treat- 
ment, and  in  preventing  the  admission  of  those  not  needing  such 
care.  It  would  also  facilitate  the  return  of  patients  from  hos- 
pitals to  their  homes,  and  would  further  their  gradual  rehabilita- 
tion in  the  industrial  world,  without  subjecting  them  to  the  extra- 
ordinary strain  which  now  ensues  too  frequently  upon  discharge 
from  a  hospital.  When  the  conditions  in  the  home  are,  or  can  be 
made,  sanitary  and  consistent  with  the  maintenance  of  a  proper 
standard  of  living,  home  care  may  be  preferable  for  certain  types 
of  patients,  notably  those  having  temporary  mild  illness,  or  mild 


12 

chronic  ailments  not  incapacitating  them  wholly  from  locomotion 
or  possibly  from  light  work. 

7.  Private  hospitals.  Many  private,  i.  e.,  non-municipal  hos- 
pitals, have  been  established  from  time  to  time.  Some  of  these 
are  supported  wholly  by  endowment  or  voluntary  contribution, 
others  receive  a  proportion  of  their  income  from  a  per  capita 
payment  from  the  public  treasury.  A  number  of  these  hospitals 
maintain  ambulance  service,  a  few  of  them  receiving  appropria- 
tions from  the  City  Treasury  for  this  purpose.  Mr.  Jacobs'  report 
contains  a  table  (see  p.  26),  showing  what  extensions  are  in 
course  of  erection,  or  definitely  planned  for  by  these  hospitals. 
In  so  far  as  additional  accommodations  become  available  through 
private  effort  (other  than  those  now  contemplated),  other  than 
by  the  enlargement  of  existing  private  hospitals,  or  the  establishment 
of  additional  ones,  the  provision  to  be  made  by  the  city  in  these 
localities  may  be  correspondingly  reduced. 

Certain  characteristics  and  advantages  of  large  general  hos- 
pitals for  the  classes  of  patients  enumerated  above  as  suitable 
for  care  in  general  hospitals  as  distinguished  from  local  hospitals 
may  profitably  be  considered.     These  are: 

1.  Patients  may  be  classified  according  to  their  ailments  for 
treatment  and  study,  separate  wards  or  pavilions  being  ex- 
clusively devoted  to  groups  of  diseases.  For  example,  in  a  hos- 
pital of  100  to  200  beds  there  will  be  at  any  one  time  only  a 
small  number  of  cases  of  any  particular  disease.  In  the  large 
general  hospital  there  will  be  always  enough  of  each  class  of 
cases  to  constitute  a  special  service,  with  a  special  visiting  staff ; 
and,  if  need  be,  a  gymnasium  for  modern  mechanical  methods 
of  exercising  paralyzed  muscles;  a  large  hydrotherapeutic  estab- 
lishment for  special  methods  of  bathing,  douching,  massaging, 
etc.;  an  elaborate  electrical  system  of  apparatus  for  treatment; 
etc.,  etc. 

2.  The  greatest  modern  discoveries  in  the  treatment  of  dis- 
ease have  been  evolved  from  large  hospital  services,  as  for  instance 
the  original  experiments  of  Lord  Lister  in  antiseptic  surgery,  and 
the  discovery  of  diphtheria  antitoxin  by  von  Behring.  In  the  treat- 
ment of  typhoid  fever,  for  instance,  one  cannot  expect  to  achieve, 
with  two  or  three  cases  in  a  ward  full  of  mixed  sreneral  diseases,  the 


13 

scientific  advances  which  may  be  obtained  in  a  large  service  pre- 
senting simultaneously  dozens  of  typhoid  cases  in  all  stages  of  the 
disease. 

3.  The  best  work  in  diagnosis  and  treatment  to-day  is  only 
possible  through  co-operation  with  a  large  clinical  laboratory, 
where  bacterial  cultures,  blood  examinations,  etc.,  can  be  made 
and  where  germicidal  serums,' antitoxins,  etc.,  can  be  prepared, 
and  where  pathological  work  can  be  carried  on.  For 
this  a  competent  staff  is  needed  and  their  work  cannot  be  scat- 
tered over  five  200-bed  hospitals,  and  done  as  well  as  it  can  be 
done  in  a  single  institution  five  times  the  size. 

4.  The  advantage  to  the  medical  profession  of  a  large,  properly 
classified  hospital  service  are  incalculable.  The  treatment  of 
the  individual  sick  within  its  walls  constitutes  but  a  small  part 
of  the  work  of  any  modern  hospital,  for  its  influence  is  educa- 
tional, and  benefits  the  entire  community.  The  visiting  and  house 
staffs  and  the  nurses  are  all  destined  to  work  ultimately  among 
the  sick  of  the  community,  a  large  majority  of  whom  never  enter 
hospitals.  The  larger  and  better  classified  the  hospital  service,  the 
greater  the  experience  and  better  the  training  given  by  it. 

5.  The  large  general  hospital  permits  the  use  of  the  low  pa- 
vilion type  of  construction,  such  as  is  seen  in  the  great  modern 
European  hospitals.  The  plan  lends  itself  readily  to  increase  in 
capacity  from  time  to  time  and  has  distinct  advantages  in  ques- 
tions of  heating,  ventilation,  light  and  segregation  and  isolation 
of  various  classes  of  patients. 

6.  New  York  City  ought  to  be  the  great  center  for  medical 
education  in  the  country,  attracting  physicians  and  nurses  for 
study  from  every  state.  At  present  this  is  far  from  the  fact.  It 
possesses  some  60  general  hospitals,  with  a  total  bed  capacity 
of  nearly  10,000,  most  of  these  hospitals  being  small  and  im- 
perfectly equipped  for  treatment,  as  compared  with  advanced 
hospital  construction  elsewhere ;  but  it  has  not  a  single  large 
general  hospital  with  a  service  classified  so  as  to  afford  wards 
for  all  the  important  types  of  disease,  and  with  all  the  structural 
and  environmental  facilities  requisite  for  treatment.  In  pro- 
portion as  minor  scattered  hospitals  invade  the  fields  of  general 
hospital  work,  outlined  above,  the  development  of  the  large 
general  hospital  type  of  structure  with  all  its  unique  possibilities 


14 

for  treatment,  for  medical  education,  for  scientific  research  and 
opportunities  for  humanitarian  medical  discovery  will  be 
retarded. 

7.  The  published  case  records  of  a  large  classified  service  are 
not  only  of  much  practical  use  to  the  institution  itself  but  are 
of  the  greatest  possible  value  to  medical  science. 

To  indicate  how  varied  the  equipment  of  a  large  modern  gen- 
eral hospital  should  be,  the  following  outline  of  what  is  provided 
in  many  modern  hospitals  elsewhere  is  presented : 

Administration  building,  separate  kitchen  and  laundry  build- 
ing, power  house,  nurses'  home,  crematory,  and  disinfection 
plant,  ice  house,  large  pathological  building  with  laboratories, 
morgue,  large  building  for  clinical  laboratory  with  bacteriologi- 
cal rooms,  etc.,  workshop  and  wagon  house,  filtration  plant,  day 
rooms  for  convalescents,  libraries  for  patients,  house  staff,  and 
pathological  department,  clinical  record  room,  large  bath  house 
containing,  besides  mechanical  apparatus,  a  gymnasium,  Roman, 
Turkish,  hot-air  and  electric-light  baths,  sand  baths,  carbonic- 
acid  baths,  showers  and  douches  of  all  kinds,  with  proper  ad- 
justments for  regulating  water  pressure  and  temperature,  be- 
sides a  large  plunge  bath  and  massage  rooms.  There  should  be 
also  inhalation  rooms  for  treatment  of  respiratory  diseases,  an 
extensive  electric  department  for  the  Roentgen  ray,  Finsen  light, 
etc.,  and  a  photograph  department.  Balconies  should  open  from 
the  wards  into  which  patients'  beds  may  be  easily  moved,  and 
flat  roofs  should  be  provided  for  exercise,  and  protected  with 
wind  shelters,  etc.,  for  open-air  treatment  of  many  diseases. 

The  increasing  variety  of  disease  other  than  tuberculosis,  such 
as  pneumonia,  anemias,  etc.,  for  which  the  medical  profession 
are  now  demanding  open-air  treatment,  emphasizes  the  import- 
ance of  placing  the  large  general  hospitals  upon  sites  remote 
from  dust,  noise  and  other  objectionable  features  of  dense  popu- 
lation environment. 

SPECIFIC  RECOMMENDATIONS. 

The  following  specific  recommendations  in  regard  to  the  loca- 
tion of  various  types  of  hospitals,  above  described,  are  respect- 
fully submitted.     As  to  each  type  of  hospital  we  have  indicated 


15 

first  what  the  existing  needs  are,  and  second  the  needs  to  1920, 
so  far  as  they  can  be  foreseen : 

EMERGENCY  RELIEF  STATIONS. 

I.     PRESENT    NEEDS. 

Manhattan. — 1.  Between  the  entrances  to  the  Brooklyn  and 
the  Manhattan  bridges,  to  the  south  and  east  of  Chatham  Square 
(unless  St.  Gregory's  Hospital  secures  sufficient  financial  sup- 
port to  insure  permanent  service). 

2.  Middle  west  side,  near  the  new  Pennsylvania  Station,  ap- 
proximately midway  between  the  New  York  and  Roosevelt 
Hospitals. 

3.  One  Hundred  and  Twentieth  Street  and  East  River,  on  or 
near  the  old  Harlem  Hospital  site. 

Brooklyn. — 4.  Near  Flushing  Avenue  and  Broadway. 
5.  South  Brooklyn,  in  Borough  Park  District,  between  Bath 
Junction  and  Ocean  Parkway. 

II.     FUTURE  NEEDS  TO  1920. 

Manhattan. — 6.  On  west  side  of  upper  Harlem,  near  Audubon 
Park,  or  to  the  north. 

7.  Bowery  and  Spring  Street. 
Bronx. — 8.  Near  Kingsbridge 
Brooklyn. — 9.  In  Williamsburg,  near  AVilliamsburg  Park. 

10.  In  Bath  Beach. 

11.  In  south  part  of  Waverly  District,  between  Remsen  Ave- 
nue and  Rockaway  Parkway,  near  Ford's  Corner  Station. 

Queens. — 12.  In  western  lamaica,  in  Woodhaven  or  Richmond 
Hill. 

13.  In  Rockaway  Beach. 

Richmond. — 14.     On  southern  shore,  near  Red  Bank. 

LOCAL  HOSPITALS. 

I.     PRESENT    NEEDS. 
.We   are   of   the   opinion   that   no   additional   local   hospitals    are 
,    required  at  present. 


i6 

II.     FUTURE  NEEDS  TO  1920. 

Local  hospitals  of  substantially  the  following  sizes  should  be 
established  in  the  following  neighborhoods,  so  as  to  be  opened 
at  approximately  the  dates  indicated  below: 

Manhattan. — 1.  One  hundred  beds  to  replace  ambulance  sta- 
tion No.  2,  on  Middle  West  Side,  by  1915. 

2.  Two  hundred  beds  to  be  added  to  the  New  Harlem  Hos- 
pital by   1920. 

3.  One  hundred  beds  on  Lower  East  Side,  near  Bowery  and 
Spring,  if  this  should  be  found  necessary,  by  1920. 

The  Bronx. — 4.  One  hundred  beds  to  be  added  to  New  Ford- 
ham  Hospital,  by  1920. 

Brooklyn. — 5.  One  hundred  beds  to  replace  ambulance  station 
No.  3,  near  Flushing  and  Broadway,  by  1912. 

6.  One  hundred  beds  to  be  added  to  Cumberland  Street  Hos- 
pital, by  1920. 

7.  One  hundred  beds  in  East  New  York,  by  1912  (The  New 
Bradford  Street  Hospital). 

8.  One  hundred  beds  in  Borough  Park  to  replace  ambulance 
station  No.  4,  by  1920. 

9.  Two  hundred  beds  to  be  added  to  New  Coney  Island  Hos- 
pital, by  1920. 

Queens. — 10.  One  hundred  beds  in  Newtown,  by  1920. 

GENERAL  HOSPITALS. 

The  new  Bellevue  EJospital  would  naturally  be  one  of  the 
general  hospitals  indicated  in  the  above  plan  of  hospital  organi- 
zation. The  present  plan  as  approved  by  the  city  authorities, 
upon  which  construction  has  made  some  progress,  provides 
with  an  ample  allowance  of  floor  space  and  cubic  air  space  for 
2,000  beds.  If  it  were  possible  to  reduce  this  number  somewhat, 
say  to  1,600  beds  without  impairing  the  value  of  the  plan  as  a 
whole,  and  with  a  view  to  expending  the  amount  so  saved  in  the 
erection  of  other  general  hospitals  elsewhere,  we  believe  such  a 
step  would  be  wise.  It  cannot  be  too  strongly  stated,  however, 
that  the  total  number  of  additional  general  hospital  beds  needed 
in  Manhattan  and  The  Bronx  by  1920  will  be  largely  in  excess 


17 

of  1, 600.  We  are  of  the  opinion,  however,  that,  beyond  enlarg- 
ing Bellevue  to  1,600  beds,  the  excess  should  be  located  prefer- 
ably elsewhere  than  at  26th  Street  and   East  River. 

Blackwell's  Island  offers  very  exceptional  and  extraordinary 
advantages  for  a  general  hospital,  including  convalescent  and 
chronic  wards,  with  its  abundance  of  light  and  air,  its  coolness  in 
summer,  its  ever-changing  panorama  of  passing  boats,  its  ac- 
cessibility to  four  of  the  five  boroughs  of  the  city,  its  cheapness 
of  maintenance  (through  water  transportation  of  fuel  and  sup- 
plies), and  the  fact  that  the  city  already  owns  the  land.  A  boat 
is  now  under  construction  for  the  Charities  Department  wrhich 
will  be  able  to  convey  an  ambulance  from  Manhattan  Island  to 
the  hospitals  on  Blackwell's  Island  in  five  minutes.  The 
present  inadequate  means  of  access  to  Blackwell's  Island,  all 
patients  being  sent  from  East  26th  Street,  and  the  boat  leaving 
but  twice  a  day,  entails  many  hardships  through  long  delays  and 
is  one  of  the  most  serious  restrictions  upon  the  usefulness  of 
the  hospitals  on  Blackwell's  Island.  It  is  exceedingly  desirable 
that  provision  should  be  made  for  the  quick  conveyance  of  am- 
bulances from  points  on  Manhattan  Island,  opposite  Blackwell's 
Island,  to  Blackwell's  Island,  at  frequent  intervals  and  with  the 
minimum  of  delay.  If  it  should  be  found  to  be  practical  to  pro- 
vide elevators  in  connection  with  the  Blackwell's  Island  Bridge, 
by  which  ambulances  and  visitors  could  reach  the  island  at  any 
time,  this  would  contribute  still  further  to  the  usefulness  of  the 
island  hospitals. 

We  recommend  that  there  be  a  general  hospital  at  the  upper 
end,  and  one  at  the  lower  end  of  Blackwell's  Island,  with  some 
administrative  features  in  common,  each  to  be  developed  to  not 
more  than  1,500  beds.  This  would  leave  the  central  two-thirds 
if  not  three-fourths  of  the  island  available  for  park  purposes  as 
soon  as  the  penal  institutions  and  the  almhouse  are  removed,, 
and  for  additional  hospital  pavilions,  if  required  in  the  future- 
While  Blackwell's  Island  offers  these  exceptional  opportuni- 
ties as  contrasted  with  the  crowded  sections  of  Manhattan, 
southeast  Bronx,  and  parts  of  Brooklyn,  its  advantages  are  not 
superior  to  these  of  the  outlying  sections  of  the  city,  and  it 
w^ould   in   our   judgment   be   a   mistake   to   bring   patients   from 


these  outlying  parts  of  the  city  to  Blackwell's  Island,  unless 
the  particular  type  of  disease  required  facilities  for  treatment, 
which  are  not  available  except  at  the  large  general  hospitals 
maintained  there  or  at  Bellevue. 

The  borough  of  the  Bronx  should  in  time  have  its  own  gen- 
eral hospital.  Fordham  Hospital,  facing  Bronx  Park,  has  an 
admirable  location  and  we  recommend  that  it  be  enlarged  as 
may  be  required  for  general  hospital  purposes  for  this  borough ; 
and  that  land  for  this  purpose  be  acquired  now,  when  it  can 
be  bought  cheaply. 

In  Brooklyn,  the  Kings  County  Hospital,  providing  at  present 
for  600  patients,  should,  in  course  of  the  next  decade,  be  enlarged 
to  a  capacity  of  1,000  patients.  There  should  also  be  established 
without  delay  an  additional  general  hospital  in  the  borough  of 
Brooklyn,  in  the  Ridgewood  district,  near  Decatur  Street,  and  Irv- 
ing Avenue,  where  excellent  sites  at  reasonable  prices  are  available. 

Wards  for  chronic  patients  already  exist  at  the  Kings  County 
Hospital,  which,  however,  are  inadequate.  Suitable  wards  for 
convalescents  should  be  provided  at  this  institution.  Both 
chronic  and  convalescent  wards  should  be  provided  at  the  pro- 
posed additional  general  hospital  in  Brooklyn.  The  additional 
beds  on  Blackwell's  Island  would  naturally  be  devoted  in  part  to 
these  classes  of  patients. 

To  sum  up,  the  proposed  additional  general  hospital  provisions 
would  be : 

I.  PRESENT  NEEDS. 

Brooklyn. — Five  hundred  beds  in  the  Ridgewood  district, 
northwest  of  the  Cemetery  of  Evergreens,  near  Decatur  Street 
and  Irving  Avenue.     (Ward  28.) 

II.  FUTURE  NEEDS  TO  1920. 

Brooklyn. — Four  hundred  beds  to  be  added  to  the  Kings 
County  Hospital. 

Blackwell's  Island. — Seven  hundred  beds  to  be  added  to  the 
City  Hospital,  and  five  hundred  beds  to  the  Metropolitan  Hospital 
(making  the  capacity  of  each  1,500  beds). 


i9 
SUMMARY  BY  TIME. 

A  summary  of  the  various  classes  of  hospitals  proposed  above, 
in  addition  to  those  now  in  course  of  construction,  on  the  basis  of 
the  proposed  date  of  construction  is  as  follows : 

I.     PRESENT.  NEEDS. 
Manhattan:  Bedg 

3  Emergency  relief  stations 24 

Brooklyn: 

2   Emergency   relief  stations 16 

1  General  hospital ' 500 

Total    present   needs 540 

II.     FUTURE  NEEDS  TO  1920. 
Manhattan : 

2  Emergency  relief  stations 16 

1  Local  hospital,  by  191 5 100 

Enlarge  Harlem  Hospital,  by  1920 200 

Enlarge  Blackwell's   Island   General   Hospitals,   by 

1920 1,200 

The  Bronx : 

1  Emergency  relief  station 8 

Enlarge   Fordham   Hospital,   by    1920 100 

Brooklyn : 

3  Emergency   relief   stations 24 

4  Local  hospitals,  2  in  1902  ;  2  by  1920 400 

Enlarge  Coney  Island  Hospital,  by  1920 200 

Enlarge  Kings  County  Hospital,  by  1920 400 

Queens : 

2  Ambulance  stations    16 

1  Local  hospital,  by   1920 100 

Richmond : 

1  Ambulance    station 8 

Total  future  needs  to  1920 2,772 

Total  present  and  future  needs  to  1920 3^312 


20 

To  provide  3,312  beds  by  1920,  would  mean  an  average  addition 
of  276  beds  per  annum. 

Respectfully  submitted, 

HELEN  F.  DRAPER, 

Acting  Chairman, 
HOMER  FOLKS, 

Secretary, 
CAROLINE  McP.  BERGEN, 
JOHN  S.  BILLINGS, 
GEORGE  BLAGDEN, 
GEORGE  F.  CLOVER, 
J.  T.  DURYEA, 
C.  IRVING  FISHER, 
LEWIS  F.  FRISSELL, 
TFIEODORE  L.   FROTHINGHAM, 
S.  S.  GOLDWATER, 
JAMES  H.  HAMILTON, 
A.  S.  KAVANAGH, 
FRANKLIN  B.  KIRKBRIDE, 
EDGAR  J.  LEVEY, 
SAMUEL  LLOYD, 
WILLIAM  P.  NORTHRUP, 
ALEXANDER  C.  PROUD  FIT, 
W.  GILMAN  THOMPSON, 
GRACE  T.  WELLS, 
LINSLY  R.  WILLIAMS, 

Committee. 


New  Hospitals  Needed  in  Greater  New  York. 


A  report  by  Phil   P.  Jacobs,- January   i,   igol 


INTRODUCTION. 

In  Greater  New  York,  where  the  care  of  the  sick  in  its  160 
hospitals  with  their  army  of  200,000  patients  treated  each  year, 
lays  annually  upon  the  municipal  and  private  purse  a  burden  of  over 
six  and  one-half  millions  of  dollars  ;  and  where  the  problems  relat- 
ing to  this  care  are  constantly  becoming"  more  and  more  complex, 
it  is  obviously  of  the  greatest  importance  that  there  should  be  some 
well-planned  and  well-regulated  system  of  hospitals  and  a  definite 
policy  upon  which  new  hospitals  should  be  located.  Yet,  this  city, 
with  a  length  of  over  35  miles  and  a  breadth  of  over  10  miles  and 
with  a  population  of  over  4,000,000,  has  nothing  which  can  rightly 
be  designated  as  a  policy  upon  which  it  can  base  the  location  of 
its  hospitals  to  meet  either  the  needs  of  the  present  or  those  of 
the  future. 

To  establish  such  a  policy,  based  upon  a  careful  consideration 
of  all  the  facts,  an  investigation  of  the  present  hospital  situation  in 
Greater  New  York  has  been  made,  in  order  that  some  scheme  might 
be  evolved,  which  should  provide  for  the  care  of  the  sick  needing 
hospital  treatment  both  now  and  up  to  1920  with  the  greatest 
degree  of  efficiency,  and  which  at  the  same  time  should  involve  a 
minimum  cost  to  the  city.  Two  objects,  or  ends  to  be  derived, 
were  kept  constantly  in  mind  in  this  investigation.  The  first  of 
these  objects  was  to  arrive  at  definitely  proven  conclusions,  as  to 
what  additional  general  hospital  accommodations  are  needed  to 
meet  the  present  needs  of  the  city.  The  second  object  was  to  gain 
definite  conclusions  by  which  we  might  be  able  to  foresee  what  new 
hospitals  will  be  needed  in  1920,  and  where  they  should  be  located 
to  meet  the  needs  of  that  date. 

The  data  on  which  this  first  question  was  decided  included  per- 
sonal visits  to  every  one  of  the  fifty-nine  general  hospitals  in  the  city, 
a  careful  personal  examination  of  the  different  districts  in  which 
these  hospitals  work,  together  with  an  analysis  of  the  population, 
and  the  number  of  sick  needing  hospital  treatment  in  each  district. 
In  determining  the  second  question  as  to  how  many  beds  are  needed 
for  future  needs,  the. subject  of  population  was  carefully  studied. 
Forecasts,   based   upon   all   the   known    factors,    such   as    increased 


22 

transit  facilities,  were  made.  The  various  facts  which  will  deter- 
mine the  number  of  people  needing  hospital  care  in  1920  were  sifted 
and  weighed  for  their  respective  values  in  drawing  conclusions. 
The  results  obtained  upon  this  part  of  the  investigation,  it  might  be 
stated  at  the  outset,  are  not  blind  guesses,  nor  superficial  conclu- 
sions, but  they  are  based  upon  a  method,  and  upon  principles  which 
insure  the  most  approximate  exactness. 

These  two  conclusions,  then,  may  be  anticipated,  that  the  city 
needs  more  hospitals  now  to  fill  the  needs  of  to-day ;  and  that  it  will 
need  many  more  hospitals  in  1920. 


CHAPTER  I. 

HOSPITAL  POPULATION. 

Census  and  Capacity  of  Existing  General   Hospitals. 

In  this  report  the  word  "  hospital,"  unless  otherwise  qualified, 
means  a  general  hospital,  i.  e.,  a  hospital  for  the  reception  and  treat- 
ment of  all  kinds  of  medical  and  surgical  cases  which  are  not  sent 
to  hospitals  established  for  the  care  of  particular  diseases  or  class 
of  diseases.  This  investigation  has  to  do  chiefly  with  the  need  for 
additional  general  hospitals.  Hospitals  for  contagious  diseases  are 
excluded  from  the  present  inquiry  because  their  extent,  location, 
and  management  involve  questions  with  which  only  the  Department 
of  Health  is  fitted  to  deal.  Admission  to  them  is  on  a  wholly  dif- 
ferent basis  from  the  admission  to  general  hospitals,  and  their  ambu- 
lance service  is  wholly  dissociated  from  the  ordinary  ambulance  ser- 
vice of  the  city.  Hospitals  and  sanitoria  for  the  care  of  tuberculosis 
are  also  excluded  from  the  present  inquiry,  partly  because  they  are 
not  a  part  of  the  general  hospital  system  of  the  city,  their  location, 
number,  and  character  being  governed  by  special  conditions,  and 
partly  because  of  the  fact  that  a  corresponding  inquiry  as  to  the 
number  of  additional  hospital  beds  required  for  cases  of  tuber- 
culosis has  been  made  by  the  Committee  on  the  Prevention  of 
Tuberculosis  of  the  Charity  Organization  Society.  We  have 
sought  to  ascertain  by  all  available  sources  of  information  the 
number  of  general  hospital  beds  required  for  the  proper  care  and 
treatment  of  the  sick  in  this  city  at  the  present  time  and  the  number 
of  additional  beds  that  will  be  required  by  the  year  1920. 

By  "  hospital  population,"  as  used  here,  is  meant  the  number  of 
people  who  are  in  the  general  hospitals  of  the  city  or  locality  on 
a  given  date. 


23 

This  study  of  hospital  population  was  made  through  personal 
canvass  of  every  hospital  in  the  city.  At  each  hospital  of  Greater 
New  York  the  census  was  taken  for  three  different  dates,  January  I, 
1905,  September  1,  1905,  and  March  1,  1906.  The  full  bed  capacity 
in  use  on  March  1,  1906,  was  also  taken.  The  reason  for  taking 
the  census  on  these  different  dates  was  that  the  variations  of  seasons 
might  be  noted  in  their  effect  upon  the  hospital  population.  Thus 
it  will  be  noted  in  Table  XIII  that  the  number  of  patients  in  the 
hospitals  of  the  city  on  March  1,  1906,  is  nearly  800  in  excess  of 
what  it  was  on  January  1,  1905.  This  is  due  chiefly  to  the  fact  that 
the  hospital  population  is  usually  smaller  in  January  than  in  March. 

Needed  Excess  in  Bed   Capacity. 

In  any  investigation  of  hospital  population  which  has  for  its  end 
the  determining  of  what  is  the  proper  bed  capacity  of  the  institu- 
tions, it  should  be  noted  first  of  all  that  this  bed  capacity  in  a 
given  institution  or  in  a  given  group  of  institutions  should  always 
exceed  considerably  the  number  of  patients.  There  are  various 
reasons  for  this.  Medical  cases  should  not  be  put  in  surgical 
wards  or  vice  versa.  Women,  moreover,  cannot  be  placed  in  male 
wards  or  the  reverse.  Adults  cannot  be  put  in  children's  wards, 
nor  can  the  ordinary  medical  or  surgical  patients  be  placed  in 
wards  used  for  isolation  of  infectious  and  contagious  diseases. 
Thus,  though  a  hospital  may  show  an  excess  of  beds  over  patients 
on  any  given  day,  it  may  still  be  overcrowded  in  many  of  its  de- 
partments. As  seen  in  Table  IX,  for  instance,  the  New  York  Post 
Graduate  Hospital  had  on  March  1st  but  161  patients  with  a  bed 
capacity  of  216.  There  were  on  that  day,  however,  seven  cots  in 
the  surgical  wards  of  the  building  and  a  waiting  list  of  over  20 
in  the  women's  surgical  ward.  In  Mount  Sinai  Hospital  about 
one-tenth  of  the  beds  in  the  institution  are  kept  constantly  in  reserve 
for  emergency  and  isolation  cases.  It  can  thus  be  seen  how  any 
hospital  or  group  of  hospitals  may  speak  of  overcrowding  and  yet 
show  from  actual  figures  a  considerable  excess  of  beds  over  patients 
in  the  hospital  on  any  given  day.  So  in  the  city  as  a  whole  there 
may  be  a  considerable  excess  of  beds  over  patients,  but  this  does 
not  necessarily  indicate  that  there  is,  then,  no  need  for  more  hospital 
accommodations.  It  may  indicate  a  needed  excess,  as  above  men- 
tioned, or  it  may  indicate  that  there  are  more  beds  in  one  locality 
than  are  necessary  and  not  enough  in  another.  On  the  other  hand 
it  may  indicate  a  certain  marked  preference  on  the  part  of  the  public 
for  some  hospitals  as  against  others.  Thus,  it  is  a  most  conservative 
estimate  to  say,  that  in  a  city  the  size  of  Greater  New  York,  at  least 
one-tenth  of  the  bed  capacity  must  be  constantly  in  reserve,  and 
that  about  another  tenth  is  very  likely  to  be  in  reserve  on  account 
of  poor  location  or  for  some  other  reason. 


24 

During  visits  to  the  hospitals  the  opinions  of  superintendents 
were  solicited  in  regard  to  needs  for  hospitals  in  their  own 
neighborhoods. 

With  these  preliminary  remarks  we  take  up  a  consideration  of  the 
hospital  population  of  the  city  by  boroughs : 

i.  Manhattan. 

In  Manhattan  the  total  number  of  patients  in  all  general  hospitals, 
including  those  on  Blackwell's  Island,  was  4,774  on  January  1,  1905  ; 
on  September  1,  1905,  it  was  4,608;  and  on  March  1,  1906,  it  was 
5,060.  The  number  of  beds  in  these  same  hospitals  on  March  I, 
1906,  was  5,917.  On  December  1,  1907,  the  number  of  patients  in 
the  twenty-five  general  hospitals  of  Manhattan  was  3,697,  exclud- 
ing the  Blackwell's  Island  hospitals,  and  including  these  two  institu- 
tions, 4,750.  The  bed  capacity  of  the  Manhattan  hospitals,  exclud- 
ing Blackwell's  Island,  on  the  above  date  was  4,858,  and  including 
the  island  hospitals,  6,175.  It  will  thus  be  seen  at  the  outset  that 
the  excess  of  beds  in  Manhattan  is  only  9.3%,  which  is  fully  10% 
under  what  ought,  even  under  the  most  ordinary  circumstances,  to 
be  allowed  for  emergency,  poor  location,  or  other  reasons. 

Besides  the  beds  now  available,  additions  to  the  present 
bed  capacity  are  contemplated,  and  some  of  them  are  already  in 
course  of  construction.  (See  Table  XX.)  The  Sydenham  Hospital 
will  soon  build  an  entirely  new  institution  of  200  beds  somewhere  in 
Harlem.  The  new  Red  Cross  Hospital  accommodates  52  patients. 
The  New  Harlem  Hospital  recently  completed  accommodates  150 
patients.  The  plans  for  a  "  Greater  Bellevue  "  with  2,000  beds  have 
been  approved  and  work  is  in  progress  on  two  pavilions,  which  will 
be  completed  in  1908.  This  will  mean  an  addition  of  1,000  beds 
to  the  present  capacity.  In  all  the  definitely  known  increases  for 
the  next  fifteen  years  will  aggregate  1,460  beds.  (See  Table  XX, 
p.  83.)  The  St.  Francis  Home  and  Hospital  on  5th  Street  has 
recently  been  closed  for  general  hospital  purposes,  and  is  used  now 
only  for  a  home  for  chronic  and  indigent  aged  patients.  The  Trinity 
Hospital  has  also  closed  its  doors.  Seven  hundred  eighty  beds  are 
being  considered  as  additions  to  different  hospitals,  but  no  definite 
plans  are  as  yet  decided  upon ;  and  these  do  not  figure  in  this  report. 
It  will  thus  be  seen  that  when  all  the  definite  additions  to  the  bed 
capacity  of  Manhattan  are  completed  there  will  be  over  6,300  gen- 
eral hospital  beds  in  the  borough  in  1920  excluding  those  on  Black- 
well's Island. 

2.  The  Bronx. 

In  the  Bronx  there  were  on  March  1,  1906,  five  hospitals  with  a 
bed  capacity  of  1,305.  The  number  of  patients  on  January  1,  1905, 
was  588.  At  a  later  season,  March  1,  1906,  the  number  had 
increased  to  841.  On  December  1,  1907.  there  were  4  hospitals 
with  1,265  beds  and  888  patients  in  the  Bronx.    The  tendency  on  the 


25 

part  of  hospital  managers  to  move  northward  in  Manhattan  and 
The  Bronx  is  evidenced  by  the  large  number  of  hospital  beds  in  the 
southern  part  of  The  Bronx.  Two  of  the  largest  general  hospitals 
in  the  city,  the  St.  Francis  and  Lincoln,  are  situated  here  within  a 
few  blocks  of  one  another,  the  former  one  being  but  recently  opened. 
Another  one  of  over  200  beds,  the  Lebanon,  is  a  short  distance 
away.  The  details  of  the  different  hospitals  in  this  section  may  be 
found  in  Table  IX,  p.  80. 

3.  Brooklyn. 

The  hospital  situation  of  Brooklyn  is  considerably  different  from 
that  in  Manhattan.  Of  the  21  general  hospitals  in  the  city  almost 
all  are  located  in  the  older  section  of  the  city.  A  line  two  miles 
long  drawn  in  a  circle  from  a  point  on  McDonough  and  Stuyve- 
sant  Streets  reaches  15  out  of  the  21  general  hospitals  now  in  opera- 
tion in  the  city,  and  within  a  two  and  a  half  mile  radius  every 
hospital  except  two  will  be  included.  It  can  thus  be  seen  at  a  glance 
that  the  outlying  sections  of  Brooklyn  are  practically  without  hos- 
pitals at  all.  On  January  1,  1905,  there  were  in  the  general  hospitals 
of  Brooklyn  2,045  patients;  on  September  1st  there  were  1,983;  on 
March  1st  there  were  2,241.  The  bed  capacity  of  the  twenty  gen- 
eral hospitals  open  on  March  1st  was  2,719.  The  new  Jewish  hos- 
pital, with  a  potential  capacity  of  200  beds,  was  opened  December 
7,  1906.  On  December  1,  1907,  the  number  of  patients  was  2,276, 
and  the  number  of  beds  in  the  21  general  hospitals  then  open  was 
;,882.  Several  additions  to  the  present  hospitals  and  more  new  hos- 
pitals are  being  planned  in  Brooklyn.  At  the  Long  Island  College 
Tospital  the  work  of  remodelling  the  entire  institution  is  under  way, 
and  when  completed  will  add  125  beds  to  the  present  capacity.  The 
new  Bradford  Street  Hospital  and  the  new  Coney  Island  Hospital 
will  accommodate  100  beds  each.  Altogether  the  definite  additions  to 
the  general  hospital  bed  capacity  of  Brooklyn  within  the  next  fifteen 
^ears  will  aggregate  918  beds,  with  about  400  more  as  indefinitely 
;onsidered.  (See  Table  XXI,  p.  83.)  When  all  these  known  addi- 
tions are  completed  the  bed  capacity  of  Brooklyn  should  be  3,800. 
Table  X,  p.  81,  gives  details  of  the  hospital  population  of  Brooklyn. 

4.  Queens. 

There  are  five  hospitals  in  the  Borough  of  Queens,  one  in  Long 
Island  City,  two  in  Jamaica,  one  in  Flushing,  and  one  in  Far 
iRockaway.  The  total  bed  capacity  of  the  five  hospitals  is  389,  and 
'they  had  288  patients  on  March  1,  1906.  The  bed  capacity  of  the 
five  hospitals  on  December  1,  1907,  was  395,  and  the  number  of 
patients  was  314.  (See  Table  XI,  p.  82.)  At  present  a  wing  to 
accommodate  125  beds  is  in  building  at  the  Long  Island  City  Hos- 
pital.   This  will  bring  the  bed  capacity  of  Queens  up  to  ove"  500. 


26 


5.  Richmond. 

The  Borough  of  Richmond  has  but  two  hospitals,  both  in  the 
northern  end  of  the  island.  These  seem  to  be  amply  sufficient  for 
all  the  present  needs  of  the  borough.  The  bed  capacity  of  the  two 
hospitals  is  231,  and  the  number  of  patients  on  March  1st  was  159. 
The  bed  capacity  of  the  hospitals  was  227  on  December  1,  1907,  and 
the  number  of  patients  was  219.  (See  Table  XII,  p.  82.)  No 
definite  plans  are  being  considered  at  present  for  additions  in  this 
borough. 

6.  Summary  for  the  Hospital  Population. 

Table  XIII,  which  follows,  gives  a  summary  of  the  hospital  popu- 
lation of  Greater  New  York.  It  will  be  seen  from  this  table  that 
there  are  59  general  hospitals  in  Greater  New  York  with  a  bed 
capacity  of  10,926  in  1908.  On  March  1,  1906,  there  were  8,589 
patients  in  the  five  boroughs,  including  Blackwell's  Island,  and  on 
January  1,  1908,  there  were  8,447.  The  total  proposed  definite  addi- 
tions to  the  bed  capacity  of  Greater  New  York  aggregate  2,853. 
When  these  additions  are  completed  there  will  be  in  Greater  New 
York  nearly  13,800  general  hospital  beds. 


TABLE  XIII. 

SUMMARY  OF  HOSPITAL  POPULATION 

GREATER  NEW  YORK. 

Beds  pro- 
posed in 
definitely 
Number  of     Number  of  Patients.      Number      known 


OF 

Borough. 

hospitals  Jan.  i, 
Jan.  1,      1905. 
1908. 

Sept.  1, 
1905. 

Mar.  1, 
1906. 

Jan.  t, 
1908. 

to 
1920. 

Remarks. 

Manhattan.. 

25 

3,477 

3.499 

3,815 

4,858 

1 ,460 

The  Bronx.. 

4 

588 

55o 

841 

1,255 

Brooklyn. .  . 

21 

2,045 

1,983 

2 ,  241 

2,874 

918 

Queens 

5 

242 

268 

288 

395 

125 

Richmond.  . 

2 

124 

121 

159 

227 

Blackwell's 
Island     ,  . 

2 

1,297 

1 ,  109 

1,245 

1,317 

350 

Totals.. 

59 

7,773 

7,530 

8,589 

10,926 

2,853 

About   1,200  beds,  in- 
definite additions. 
are  being  considered, 
but    no     plans  com- 
pleted. 

27 


CHAPTER  II. 

GENERAL  POPULATION. 

The  Index  of  Future  Growth  is  Past  and  Present  Growth. 

In  considering  the  general  population  of  Greater  New  York  in 
its  effect  upon  the  problem  of  hospital  location,  it  is  of  great  impor- 
tance to  note  both  the  growth  and  the  distribution  of  the  great 
masses  of  people  who  have  come  into  the  city  within  the  last  25 
years.  In  order  that  a  forecast  of  the  population  in  1920  may  be 
made,  it  is  necessary  to  ascertain  both  the  past  and  the  recent  growth 
of  the  city  in  its  different  sections.  To  obtain  an  adequate  idea  of 
this  growth  the  subject  was  approached  in  two  ways.  The  actual 
increases  for  five,  ten,  fifteen,  and  twenty-five  year  periods  with  the 
percentages  of  increase  were  obtained  for  each  ward  in  the  entire 
city.  Then  these  were  summarized  and  the  results  tabulated  bv 
boroughs.  (See  Tables  I,  III,  IV,  V,  and  VIII.)  By  this  method 
the  percentage  of  growth  in  every  ward  and  district  of  the  city 
was  obtained.  A  second  way  of  securing  the  same  results  was 
through  a  comparison  of  the  density  of  population  in  the  different 
wards  for  fifteen  years  back.  This  showed  the  increases  in  the 
number  of  people  per  acre  in  the  different  localities,  denoting 
whether  a  district  was  being  built  up  or  not,  or  whether  it  was 
crowded  beyond  a  proper  limit.     (See  Tables  II,  VI,  and  VII,  pp. 

74-79-) 

1.  Manhattan. 

Approaching  the  subject  of  population  of  Manhattan  from  the 
standpoint  of  actual  increase  in  numbers,  we  note  that  during  the 
past  twenty-five  years  the  population  of  Manhattan  has  increased 
75.1%.  (See  Table  I,  p.  74.)  This  figure,  however,  does  not  indi- 
cate the  great  movements  and  changes  in  population  which  have 
taken  place  in  Manhattan  during  that  period.  Table  I  shows  that,  of 
the  22  wards  in  Manhattan,  13  decreased  in  population  between  1880 
and  1890,  although  the  borough  as  a  whole  increased  25.6%.  In 
the  next  decade  8  wards,  including  6  of  the  13  above  mentioned, 
show  a  decrease,,  while  the  city  increased  22.9%.  For  the  period 
between  1900  and  1905,  there  was  an  increase  in  all  the  wards  but 
five,  only  one  of  them  having  decreased  in  the  two  preceding 
decades.  The  total  increase  for  the  borough  was  14.2%.  Con- 
sidering the  twenty-five-year  .period  as  a  whole,  we  note  that  of 
the  six  wards  which  show  a  decrease,  four  are  below  Canal  Street. 
The  two  others  are  just  above  Canal  Street  on  the  west  side.  All 
of  these  wards  are  in  a  section  where  business  is  rapidly  driving  out 
the  resident  population  and  where  few  people,  except  the  janitors 
of  blocks,  now  live.  In  fact,  the  section  below  Canal  Street,  com- 
prising wards  1,  2,  3,  4,  5,  and  6,  when  taken  as  a  whole  shows  an 


28 

almost  steady  decrease.  The  district  just  above  this  on  the  West 
Side,  containing  wards  8,  9,  14,  and  15,  has  remained  almost  sta- 
tionary in  population  for  25  years.  But  on  the  East  Side,  between 
Canal  and  14th  Streets,  the  population  has  increased  59%  in  the 
past  25  years.  The  territory  between  14th  and  40th  Streets  has 
remained  almost  stationary*,  increasing  less  than  5%  for  25  years. 
This  is  due,  also,  to  the  growing  business  interests  of  the  district. 
On  the  other  hand,  the  up-town  wards  have  shown  phenomenal  in- 
creases in  the  same  period.  From  1880-1905  wards  19  and  22,  lying 
between  40th  and  86th  Streets,  increased  87.8%,  while  the  12th 
ward,  comprising  all  north  of  this  district,  multiplied  its  population 
seven  times,  increasing  627.2%.  It  will  thus  be  seen  that  the  whole 
tendency  of  the  population  of  Manhattan,  so  far  as  it  is  moving 
within  the  borough  itself,  seems  to  be  towards  the  northward,  into 
Harlem  and  the  Bronx  sections.  The  lower  East  Side,  comprising 
wards  7,  10,  11,  13,  and  17,  although  it  is  increasing,  and  has 
to-day  a  very  large  population,  is  nevertheless,  increasing  at  a 
decreasing  ratio  to  the  population  of  Manhattan  as  a  whole.  The 
up-town  sections,  above  mentioned,  are,  however,  increasing  at  an 
increasing  ratio  to  the  population  of  Manhattan  as  a  whole.  This 
is  very  obvious  when  we  note  that  in  1880  the  wards  7,  10,  11,  13, 
and  17,  comprising  the  lower  East  Side,  held  25.4%  of  the  entire 
population  of  the  city,  while  the  three  uptown  wards,  the  12th,  19th, 
and  22d,  contained  29.1%.  In  1905,  however,  the  percentage  of 
the  entire  population  in  the  Lower  East  Side  wards  had  decreased 
to  23.1%,  while  that  in  the  uptown  wards  had  almost  doubled, 
increasing  to  52.2%. 

Density  and  Population. 

The  increase  of  the  population  of  Manhattan  is  further  noticed  in 
Table  II,  p.  75,  which  shows  the  growth  in  density  of  the  city  by- 
wards  from  1890  to  1905.  The  city  as  a  whole  increased  58.74  per- 
sons per  acre  in  the  15  years,  which  seems  all  the  more  remarkable 
when  it  is  considered  that  there  are  10  wards  of  Brooklyn  which  to- 
day have  a  less  density  than  55  per  acre,  and  that  the  density  of  the 
borough  of  Queens  is  less  than  3  persons  per  acre.  As  is  gen- 
erally known  the  Lower  East  Side  is  the  most  densely  settled  area 
of  the  city,  some  districts  containing  nearly  1,000  persons  per  acre. 
In  every  ward  in  this  section,  except  the  10th  and  13th,  from  which 
considerable  area  was  taken  out  for  the  approach  to  the  new  Wil- 
liamsburgh  bridge,  there  has  been  an  increase  of  density  within  the 
last  five  years.  Between  1900  and  1905  the  nth  ward  increased 
99  persons  per  acre.  The  17th  ward,  adjoining  it,  increased  57 
persons  per  acre.  Although  the  growth  in  the  uptown  wards  does 
not  show  so  large  increases  per  acre,  the  size  of  these  wards  is  much 
larger  than  the  downtown  ones,  and  hence  the  density  growth  would 


29 

not  be  so  marked.  A  growth  of  26  persons  per  acre  in  the  12th 
ward  in  five  years  is  a  far  larger  growth  proportionately  than  one 
of  50  on  the  Lower  East  Side,  whos.e  five  wards  have  less  than  one- 
fifth  of  the  area  of  the  12th  ward. 

2.  The  Bronx. 

Twenty-five  years  ago  the  Bronx  was  considered  the  "  country." 
With  a  population  of  but  little  over  50,000  in  1890,  it  has  increased 
205.5%  within  the  last  fifteen  years  and  had  in  1905  a  population  of 
over  270,000.  Between  1900  and  1905  the  increase  in  the  Bronx 
was  354%.  As  before  stated,  the  population  of  Manhattan,  moving 
northward,  is  finding  relief  from  the  over-crowded  sections  of  the 
down-town  districts  in  the  suburban  sections  of  the  Bronx  and 
Harlem.  Table  I  shows  the  increase  in  the  Bronx  for  the  different 
periods  from  1890  to  1905. 

3.  Brooklyn. 

The  increase  in  Brooklyn  from  1880  to  1905  was  125.9%,  which 
is  50%  greater  than  the  increase  in  Manhattan  for  the  same  period. 
The  most  rapid  growth  in  Brooklyn  has  been  during  the  last  five 
years,  a  growth  which  is  going  on  at  present.  While  several  of  the 
wards,  as  shown  in  Table  III,  p.  76,  show  decreases  for  the  periods 
before  1900,  only  one  shows  a  decrease  for  the  period  of  1900  to 
1905,  and  this  decrease  of  less  than  2%  was  in  the  13th  ward,  where 
a  large  number  of  buildings  were  destroyed  to  make  way  for 
the  new  bridge  plaza.  The  most  rapid  growth  in  Brook- 
lyn has  been  in  the  territory  annexed  in  the  last  fifteen  years  in  the 
East  New  York,  Flatlands  and  Bay  Ridge  sections.  Within  the 
five  years  from  1900  to  1905  the  population  increased  42.4%  in  the 
26th  ward,  which  comprises  East  New  York  and  Brownsville ; 
50.4%  in  the  30th  ward,  comprising  Bay  Ridge,  Bath  Beach,  etc. ; 
53.4%  in  the  31st  ward,  taking  in  a  large  area  of  Flatbush ;  and 
60.5%  in  the  32d  ward,  comprising  the  town  of  Flatlands.  Among 
the  other  sections  of  Brooklyn  showing  rapid  growth  between  1900 
and  1905  are  the  24th  and  29th  wards,  east  and  northeast  of  Pros- 
pect Park.     The  latter  ward  gained  58.4%  in  the  five-year  period. 

Density. 

• 

Unlike    Manhattan,    there    are   no    wards   in    Brooklyn   which 
have     a     very     large     density     of     population,     and    there     are 
none     which     show     within     five     years     anything     of     an     in- 
crease   approaching    to__  fifty    persons    per    acre.        The     16th 
\ward,  which  has  249.3  persons  per  acre    (see  Table  VI,  p.   78), 
increased    18    persons    per    acre    during    the    past    five   years. 
I  From  this  figure  in  the   16th  ward,  which  presents  the  maximum 
I  density  in  Brooklyn,  the  density  of  the  different  sections  of  Brook- 
lyn drops  to  less  than  three  persons  per  acre  in  the  32d  ward.     The 


3Q 

Borough  of  Brooklyn  as  a  whole  has  a  density  of  but  33.9  persons 
per  acre,  as  compared  with  187.3  persons  per  acre  in  Manhattan. 
There  are  20  wards  out  of  a  total  of  32  in  Brooklyn  which 
have  a  density  under  100  per  acre.  It  will  thus  be  seen  at  a  glance 
that  there  are  large  tracts  of  Brooklyn  which  are  but  sparsely  settled 
and  that  the  number  of  vacant  lots,  even  in  the  most  crowded  sec- 
tion, is  far  in  excess  of  what  it  is  in  Manhattan,  a  fact  which  means 
that  Brooklyn  has  much  more  room  than  Manhattan  to  develop 
and  grow. 

4.  Queens. 

The  most  rapid  growth  of  population  in  any  borough  of  Greater 
New  York  during  the  past  twenty-five  years  has  been  in  the 
Borough  of  Queens.  From  less  than  60,000  in  1880,  the  Borough 
of  Queens  has  increased  to  nearly  200,000  in  1905,  or  at  the  rate 
of  268.3%.  This  is  more  than  double  the  rate  of  increase  in 
Brooklyn  and  nearly  four  times  that  of  Manhattan.  Of  the  various 
sections  of  Queens,  the  2d  ward,  comprising  the  town  of  Newtown, 
has  had  the  most  rapid  increase  within  the  past  25  years,  while 
three  of  the  four  remaining  wards  have  increased  over  100%.  (See 
Table  IV,  p.  76.) 

As  before  stated,  the  density  of  Manhattan  is  187.3,  and  that  of 
Brooklyn  33.9  per  acre.  The  density  of  Queens  is  but  2.4  per 
acre.  When  it  is  considered  that  the  area  of  Queens  (88,863 
acres)  is  more  than  double  that  of  Brooklyn,  and  is  seven  times  that 
of  Manhattan,  it  can  be  seen  at  once  how  large  an  area  of  Queens 
is  sparsely  settled,  and  what  an  opportunity  is  offered  for-  increase 
in  population. 

5.  Richmond. 

Richmond  is  the  only  borough  of  Greater  New  York  which  is 
increasing  at  a  decreasing  ratio  to  the  city  as  a  whole.  The  increase 
in  Richmond  from  1880  to  1905  is  86.8.  For  the  first  two  decades, 
from  1880  to  1890,  the  population  of  Richmond  increased  at  a  com- 
paratively rapid  rate.  But  for  the  last  five  years  it  has  not  increased 
very  rapidly,  only  8.7%.'  (See  Table  V.)  The  largest  increases 
between  1900  and  1905  have  been  in  wards  1,3,  and  5,  or  the  towns 
of  Castleton,  Northfield  and  Westfield.  The  eastern  end  of  the 
island  has  had  but  slight  increase,  and  in  the  4th  ward,  Southfield, 
there  was  a  slight  decrease. 

6.  Estimate  of  Increase  in  Population  of  Greater  New  York 

to  1920. 

In  1905,  according  to  the  New  York  State  census,  Manhattar 
had  a  population  of  2,112,380.     The  increase  from   1900  to  1905  I 
was  at  the  rate  of  14.2%.     Figures  show  that  during  the  past  fifteen  ' 
years  Manhattan  has  not  only  increased  at  the  same  rate  as  for 


3i 

fifteen  years  before,  but  it  has  compounded  its  increment.  Thus  it 
seems  a  safe  estimation  for  fifteen  years  to  come  to  triple  the  actual 
increase  of  Manhattan  from  1900  to  1905  and  add  besides  10%  of 
the  quinquennial  increase,  compounded  each  five  years.  Thus  for 
example,  the  increase  in  population  of  Manhattan  from  1900  to 
1905  was  262,604.  Ten  per  cent  of  this  amount  compounded  each 
five  years  would  be  31,774.  By  adding  this  figure  to  three  times 
the  above  increase  (786,812)  we  make  the  population  of  Manhattan 
in  1920  stand  at  2,931,288,  or  an  increase  for  the  15  years  of  34.1% 
as  compared  with  39.4%  from  1890  to  1905. 

The  Bronx,  with  its  rapid  increase  in  population,  will  undoubtedly 
keep  up  its  present  rate  of  increase,  and  it  is  probably  a  safe  esti- 
mate to  say  that  a  20%  increase  will  not  be  too  much.  This  should 
make  the  population  of  the  Bronx  in  fifteen  years  445,449,  an 
increase  of  63.9%  for  the  fifteen  years,  as  compared  with  205.5% 
from  1890  to  1905. 

On  a  most  conservative  estimate  of  increase  for  the  next  fifteen 
years  Brooklyn  should  have  2,284,264  people  in  1920,  an  increase 
of  68.6%  for  the  fifteen  years  slightly  larger  than  the  increase 
61.5%  for  1890  to  1905. 

Queens,  on  a  basis  of  30%  quinquennial  increase,  should  have 
406^676,  an  increase  of  105.1%  as  compared  with  127.7%  from 
1890  to  1905.  Richmond,  on  a  basis  of  10%,  should  have  94,700, 
or  a  30%  increase,  as  compared  with  40.9%  from  1890  to  1905. 

Thus  the  population  of  Greater  New  York  in  1920  would  be 
6,162,377.  This  is  an  increase  of  53.5%  for  the  next  fifteen  years, 
as  compared  with  55.5%  increase  from  1890  to  1905.  This  rate 
of  growth  for  the  next  fifteen  years  is,  perhaps,  too  conservative 
in  crediting  the  city  with  a  lesser  migration  from  outside  sources 
than  before,  in  spite  of  the  fact  that  this  migration,  especially  that 
from  country  to  town,  is  increasing.  It  is  deemed  well,  however, 
to  have  a  conservative  estimate  here,  in  order  that  due  allowance 
may  be  made  for  any  prevention  of  the  city's  growth,  and  for  any 
false  speculation  on  the  future  of  New  York.  It  is  thought,  there- 
fore, that  6,162,377  will  be  the  population  of  the  city  at  least  by 
1920. 

The  above  estimation  of  population  in  1920  is  taking  into  con- 
sideration the  probable  effect  of  the  improved  rapid  transit 
facilities  to  Long  Island  and  to  the  upper  end  of  Manhattan 
and  the  Bronx.  There  is  little  doubt,  when  all  the  tunnels 
under  the  East  River  are  completed  and  the  transit  facili- 
'ties  to  the  Bronx  are  made  more  adequate,  that  population 
\will  flow  in  these  directions.  Brooklyn  also  will  receive  its  share 
of  the  increase.  Between  1900  and  1905  in  both  Brooklyn  and 
Manhattan,  although  the  population  increased  very  rapidly,  the 
percentage  of  the  population  of  Greater  New  York  was  less  in  1905 
than  in  1900  in  both  of  these  boroughs.     In   1900  Brooklyn  had 


32 

33-9%  °f  the  population  of  Greater  New  York.  In  1905  it  had 
decreased  to  33.8%.  In  Manhattan  a  larger  decrease  was  noted, 
viz.,  from  53.8  to  52.6.  In  the  Bronx  and  Queens,  however,  the 
percentage  of  population  of  Greater  New  York  increased.  This 
fact  seems  to  indicate  also  that  the  population  is  moving  to  the 
suburbs.  But,  if  present  indications  are  of  any  value,  Brooklyn, 
as  the  above  estimation  shows,  should  have  a  share  of  the  population 
of  the  Greater  City  more  nearly  equal  to  that  of  Manhattan  in  1920. 
These  two  movements  then  must  be  accounted  for  in  the  study  of 
population,  the  filling  up  of  the  suburbs  of  Queens,  the  Bronx  and 
Richmond,  and  the  more  rapid  development  of  Brooklyn. 


CHAPTER  III. 

SICKNESS  AND  HOSPITAL  NEEDS. 

How  Proper  Bed  Capacity  is  Computed. 

An  investigation  of  hospital  accommodations  which  entirely 
ignores  the  amount  of  sickness  requiring  hospital  care  in  a  city  or 
a  given  locality  must  be  incomplete.  To  attempt  to  locate  new 
hospitals  or  to  add  to  existing  ones  without  some  general 
idea  at  least  of  the  number  of  sick  in  a  district  requiring  hospital 
care,  is  obviously  an  anomaly.  Yet  such  actually  has  been  the 
method  of  location  of  hospitals  heretofore  in  this  city.  If  the 
casual  observer  should  inquire  of  almost  any  hospital  superintendent 
in  New  York  how  many  sick  people  there  were  in  his  district  who 
were  requiring  hospital  attention  he  would  receive  from  the  hos- 
pital official  an  answer  to  the  effect  that  he  didn't  know  and  had 
never  thought  of  that  phase  of  his  work.  While  it  is 
true  that  the  present  distribution  of  general  population, 
as  well  as  that  of  the  hospital  population,  discussed  in  the 
two  preceding  chapters,  may  serve  as  a  basis  for  calculating  the 
number  and  distribution  of  those  needing  hospital  care,  it  must  be 
supplemented  by  a  careful  computation  from  all  data  available  as 
to  the  exact  number  of  sick  persons  in  any  given  district.  It  is 
evident  that,  if  the  number  of  sick  in  any  given  locality  who  are  in 
need  of  treatment  in  a  general  hospital  can  be  obtained,  we  have 
here  a  comparatively  safe  and  reliable  index  as  to  how  many  genera 
hospital  beds  are  needed  in  this  district.  To  find  this  index  was  tht  ' 
main  object  of  this  part  of  the  investigation. 

The  scarcity  of  material  at  this  point  necessitated  the  working  \ 
out  of  an  entirely  new  method.  Except  for  a  few  cursory  studies  \ 
of  sickness  in  the  writings  of  Dr.  William  Farr  of  London,  for  • 
forty   years    superintendent   of   the   Statistical    Department   of   the 


33 

Registrar  General's  office ;  in  those  of  Dr.  Arthur  Newsholme  of  the 
University  of  London,  and  a  few  other  European  writers,  there 
was  little  data  that  could  be  found  on  this  subject.  More  than 
twenty-five  years  ago  Dr.  Farr,  who  is  considered  the  founder 
of  the  science  of  Vital  Statistics,  made  the  statement,  "  It  has  been 
found  by  experience  that  in  England  to  one  annual  death  two  are 
on  an  average  constantly  suffering  from  sickness  of  some  severity." 
("Vital  Statistics,"  page  498.)  This  statement  has  been  accepted 
upon  Farr's  investigation  without  much  unfavorable  comment  up 
to  the  present  time.  In  Table  XIV  the  attempt  was  made  to  verify 
Farr's  figure,  or  to  obtain  some  other  figure  which  would  give  a 
fixed  ratio  between  both  mortality  and  sickness,  and  sickness  and 
population.  Dr.  Farr  and  others  who  attempted  to  establish  this 
ratio  did  so  through  a  study  of  a  large  number  of  registered  cases 
of  sickness  in  different  friendly  societies.  The  difficulty  with  the 
result  thus  obtained,  however,  was  that  the  rate,  in  the  end  became 
an  estimation  for  a  large  population  from  a  comparatively  small 
number  of  cases.  The  method  employed  in  this  report  is  not  an 
estimate,  but  is  a  deduction,  the  conclusions  of  which  are  derived 
from  well  founded  premises. 

Method  of  Computing  Number  of  Sick. 

The  premises  from  which  the  conclusions  in  Table  XIV  are 
derived  are,  that  in  every  disease  there  is  an  average  rate  of  mor- 
tality which  can  be  computed  for  any  given  period ;  that  there  is  an 
average  duration  for  each  disease  which  at  any  given  period  can  be 
calculated  approximately ;  and  that  with  these  two  facts 
and  the  number  of  deaths  during  a  year  or  other  period  in  the  dis- 
ease given,  the  daily  average  number  of  sick  can  be  computed.  The 
first  column  in  Table  XIV  gives  the  name  of  each  disease  from 
which  death  occurred  in  Greater  New  York  in  1905,  the  notation 
being  that  of  the  Department  of  Health.  The  second  has  the  num- 
ber of  deaths  for  the  year  as  taken  from  the  Department  of 
Health  reports.  Column  three  gives  the  percentage  of  fatalities, 
which  has  been  found  from  best  medical  sources  available  to  be  the 
average  in  each  disease.  The  facts  here  are  taken  from  standard 
works  on  Vital  Statistics,  and  from  experience  and  testimony  where 
it  was  of  the  highest  standard.  Among  some  of  the  physicians 
:onsulted  were  Drs.  Hitchcock,  Dana,  and  Jacobi.  That  an  exact 
nortality  rate  and  average  duration  of  illness  from  each  disease  can- 
ot  be  obtained,  owing  to  the  many  variations  of  age,  sex,  climate 
.nd  housing  conditions,  etc.,  is  admitted,  but,  considering  New 
7ork,  with  its  4,000,000  people  as  a  whole,  the  averages  here  will 
;e  found  in  the  main  "correct. 


34 


TABLE  XIV— SHOWING  AMOUNT  OF  SICKNESS  IN  GREATER  NEW  YORK  IN  1905. 

Percentage 
Number    of  deaths       Number 

of  deaths  or  mortal-       of  cases  Total  days 

in  each        ity  rate        occurring       Average  sickness        Average 

disease       in  each  in  each         duration  in  each  daily 

for         disease  in        disease  in  days         disease  in       sickness 

year  year  in  of  each  year  during 

Name  of  Disease.  1905.  1905.  1905.  disease.  1905.  1905. 

Acute  diseases  excluding 
contagious: 

Typhoid  fever 649  1.15  4,333  40  173,320  475 

Meningitis,      simple      and 

cerebrospinal 2,584  2.75  3,445  3i4  48,230  132 

Tubercular  meningitis. ...  644  4.7S  859  56o  41,540  114 

Congestion,  hemorrhage  & 

softening  of  the  brain .  .        2,891  4-75  3,855  43o  115,650  317 

Pneumonia,         excluding 

broncho-pneumonia....        5,657  4.2o  28,285  430  848,550  2,325 

Broncho-pneumonia 4,126  4-3o  13, 753  46o  825,180  2,261 

Diarrhea     and     enteritis, 

(largely  under  2  years) .        5,877  6.3o  19,590  7  137,130  376 

Acute  bronchitis 1,417  4  0=;  28,340  7i4  396,760  1,087 

Puerperal  diseases,  includ- 
ing septicaemia 815  8.2o  4,075  8i4  57,050  157 

Malarial  fever 53  5.oi  5,300  56o  318,000  871 

Influenza 311  4.oi  31,100  4io  311,000  852 

Diseases  of  stomach  (most- 
ly acute) 512  9   20  2,560  93o  76,800  212 

Hernia  and  intestinal  ob- 
structions (acute  stage)  570  '.50  1,140  'io  11,400  32 
Violent  deaths,  including 

ing  suicides,  etc 4,476  10.025  179,040  u5o        8,952,000        24,526 

All  other  diseases,  unclas- 
sified &  including  mostly 
those  of  acute  nature .  .        9,500  9.oi  950,000  9io        9,500,000        26,025 

Totals  for  acute  diseases .  .      40,082  .032        1,275,675  17.1      21,812,610        59,763 

Totals  for  chronic  diseases      21,664  .193  111,824  98-7      11,044,980        30,216 

Chronic  diseases  excluding 
tuberculosis: 

Cancer 2,875  5-75  3,887  530o        1,116,100  3,195 

Brights  disease 5,944  5-3o  19,813  5ioo        1,981,300  5,255 

Congenital     debility     and 

malformation 4,341  V50  8,682  '90  771,380  2,113 

Cirrhosis  of  the  liver 907  '.50  1,814  5ioo  181,400  497 

Senile  debility 723  10-75  964  106oo  578,400  1,584 

Organic  heart  disease 5,140  4-5o  10,280  ?ioo        1,028,000  2,843 

Chronic  bronchitis 315  4.oi  31,500  56o        1,890,000  5,J78 

Non-cancerous  tumors  and 
other  female  genital  dis- 
eases   (chronic) 327  9.oi  32,700  9ioo       3,270,000  8,953 

Ill-defined   causes,   chiefly 

marasmus 1,092  l-S°  2,184  'ioo  218,400  598 

Total  acute  and  chronic 
excluding    contagious 

and  tuberculosis 61,746  043      1,387,499  23.8     32,857,590       89,979 

Contagious  diseases  exclud-  *• 

ing  typhoid  fever: 

Diphtheria i,544  1.ii3  13,673  7.  225  341,825  936 

Smallpox 9  1 .  195  46  24o  1 ,  840  5 

Measles 520         4,2.oi  52,000  2io  520,000  1,425 

Scarlet  fever 473  1.os8  8,071  435  282,485  774 

Whooping  cough 408         4,  9.oi  40,800  5,  9io  408,000  1,118 

Totals  contagious  diseases.        2,954  .026  114,590  135        1, 554, 150  4,258 

Tuberculosis,   excluding 

tubercular  meningitis..        9,014  12.3o  30,046  125oo     15,023,000       41,1.19 

Total,  all  diseases 73,714  -048      1,532,135  32.2     49,434,740      135, 3*6 

department  of  Health  reports.  20sler,  Practice  of  Medicine. 

3Owing  to  high  death  rate,  duration  is  short.  Osier  and  Gould  both  agree  with  above  figur ■;. 
Dr.  Hitchcock  of  New  York  says  this  is  usual  duration. 

4Gould  &  Pyle,  Encyc.  of  Med.  and  Surg.  5Estimated  from  Gould  &  Pyle. 

6The  rate  is  estimated  from  Gould  and  Pyle  and  is  taken  lower  than  might  be  expected  be- 
cause summer  of  1905  was  not  very  hot. 

7Pepper,    System    of    Medicine.  8Estimated  from  Pepper. 

9Estimated  from  general  medical  reading  and  testimony,  together  with  information  from 
Department  of  Health. 

12Records  of  Homes  for  Aged  and  Infirm,  B.  I. 

10Mayo-Smith,  Statistics  and  Sociology,  pp.  159  and  160. 

uMayo-Smith,   p.    157.  13C.  Easton  in  Report  on  Tuberculosis  in  N.  Y. 


35 

Column  four  shows  the  number  of  cases  arising  in  the  disease 
during  the  year,  including  both  the  fatal  ones  and  all  others  which 
were  in  existence  during  the  year  1905.  These  figures  are  obtained 
by  dividing  the  number  of  deaths  in  column  two  by  the  death  rate 
in  column  three.  For  instance,  if,  as  in  typhoid  fever,  there  were 
649  deaths  in  1905,  and  15%  of  all  the  cases  were  fatal,  the  number 
of  cases  of  typhoid  would  be  obtained  by  dividing  the  percentage, 
649,  by  the  rate,^,  giving  4-333-* 

Column  five  gives  the  average  duration  in  days  of  each  disease. 
These  figures  are  obtained  from  sources  similar  to  those  in  column 
three.  Here  again  the  variations  which  would  effect  the  fatality 
rate  would  be  evident.  This  column,  therefore,  does  not  profess 
to  give  an  exact  prognosis  as  to  the  length  of  each  disease  that 
would  fit  all  conditions,  but  to  show  as  nearly  as  possible  what, 
during  1905,  might  be  considered  as  the  average  duration  of  the 
different  diseases.  The  length  of  sickness,  moreover,  is  somewhat 
shorter  in  all  diseases,  perhaps,  than  might  be  expected.  This  is 
due  to  the  fact  that  by  sickness  here  we  have  meant  only  bedfast 
sickness,  or  such  a  disease  as  would  keep  an  individual  in  bed, 
and  would  possibly  require  hospital  treatment.  On  this  account 
the  table  shows  only  the  more  serious  sickness  of  the  city,  leaving 
out  the  ills  which  bother  for  a  day  or  two  and  are  never  in  them- 
selves a  cause  of  death.  The  average  duration  given  in  the  chronic 
diseases  is  that  which,  from  the  best  medical  testimony,  is  judged 
to  be  the  average  amount  of  incapacitation  during  the  year. 

Column  six  shows  the  number  of  days  sickness  in  Greater  New 
York  from  all  fatal  diseases  during  the  year  T.905.  The  figures 
are  obtained  by  multiplying  the  number  of  cases  in  column  four  by 
the  average  duration  in  days.  Then  by  dividing  the  total  number 
of  days  of  sickness  by  365  (days  in  a  year)  the  average  daily  sick- 
ness in  Greater  New  York  in  1905  is  computed  as  135,396.  We 
reach  a  conclusion,  therefore,  by  data  based  on  wide  observation 
and  by  vital  statistics,  which  closely  approximates  exactness.  This 
conclusion  is  that  the  average  number  of  persons  sick  daily  in 
Greater  New  York  is  135,396. 

To  show  how  closely  the  results  of  this  table  come 
to  those  of  Farr  and  others,  some  comparisons  are  here 
given.  The  total  number  of  daily  sick  (135,396)  shows 
that  for  every  annual  death  in  New  York  during  1905 
there  were  on  an  average  1.83  persons  constantly  sick,  thus 
practically  verifying  Dr.  Farr's  figure,  given  above,  that  for  every 
annual  death  there  are  two  people  sick.  From  further  figures 
given  by  Farr  and  Newsholme  it  is  found  that  in  English  and 
Scotch  Benefit  Societies  from  1.4  to  4.5  men  are  constantly  sick  in 

*For  demonstration,  let  x  equal  the  number  of  cases  in  a  disease  during  a  year.  Then,  as  in 
ty:''.ioid  fever,  15%  of  x  equals  649,  the  number  of  deaths.  Then  649  divided  by  15%  equals 
x,    -juals  4,333, 


36 

every  ioo  members.  The  result  of  Table  XIV  gives  the  sick  rate 
of  New  York  as  3.3,  which  seems  to  be  a  fair  mean,  inasmuch  as 
the  above  societies  take  only  men  for  membership  and  are,  besides, 
very  careful  in  the  selection  of  these  members. 

The  Hospital  Rate. 

Having  found  the  total  number  of  sick,  it  remains  to  find  out 
what  percentage  of  the  sick  are  in  need  of  treatment  in  the  general 
hospitals  of  the  city.  For  the  purpose  of  securing  this  ratio  the 
amount  of  sickness  in  acute  and  chronic  cases  only  (excluding 
tuberculosis  and  contagious  diseases)  was  used.  Manifestly  those 
who  are  sick  with  contagious  diseases  cannot  be  treated  in  general 
hospitals  on  account  of  the  danger  of  infection.  We  are  now  com- 
ing to  see  that  a  like  reason  should  exclude  from  general  hospitals 
those  sick  with  tuberculosis,  and  have,  in  fact,  excluded  this  class 
from  all  the  regular  wards.  Both  the  ordinary  contagious  diseases 
and  tuberculosis  demand  special  kinds  of  hospital  treatment  other 
than  what  can  be  furnished  by  a  general  hospital.  The  number  of 
sick,  then,  of  acute  and  chronic  diseases,  excluding  contagious  and 
tuberculosis,  is  seen  to  be  88,669.  We  find  from  this  figure  that 
2.21  persons  out  of  even-  100  of  population  in  Greater  New  York 
are  constantly  sick  of  these  acute  or  chronic  diseases. 

From  Table  XIII  it  will  be  seen  that  on  January  1,  1905,  there 
were  7,773  patients  in  the  general  hospitals  of  Greater  New  York. 
Taking  this  figure  for  a  basis  it  will  be  found  that  of  the  88,669 
persons  daily  sick  of  acute  and  chronic  diseases  in  Greater  New 
York  in  1905  8.4%  actually  were  in  general  hospitals  of  the  city. 

The  testimony  of  hospital  superintendents  and  those  who  have  to 
do  with  hospitals  is  that  there  are  always  in  the  community  a  large 
number  of  sick  people  who  ought  to  be  in  hospitals,  but  who  are 
not  there,  and  this,  too,  in  spite  of  the  increase  of  home  treatment. 
The  head  workers  of  the  largest  district  nursing  system  in  this 
city  assert  confidently  that  they  find  from  their  varied  experience 
that  there  are  large  numbers  of  sick  people  who  are  receiving 
improper  or  insufficient  treatment  at  home,  and  who  should  rightly 
be  cared  for  in  hospitals.  '  Various  reasons  may  be  assigned  for 
this  condition.  Many  people,  for  instance,  would  go  to  hospitals 
if  they  could  pay  for  their  maintenance  there,  but  being  unable  to 
pay,  they  endure  the  inadequate  treatment  at  home  rather  than 
receive  hospital  treatment  as  a  gift  of  charity.  Others  refuse  abso- 
lutely to  go  to  hospitals,  because  of  the  lack  of  confidence  in  the 
management  of  all  such  institutions.  This  horror  of  the  hospital, 
which  has  been  created  largely  by  the  yellow  press,  is,  however, 
decreasing  and  more  people  are  going  to-day  than  ever  before. 
Still  another  reason  why  many  people  stay  at  home  when  sick  instead 
of  going  to  a  hospital  is  because  they  hate  to  be  separated  from 


37 

their  families.  Probably,  however,  one  of  the  weightiest  reasons 
why  there  are  people  who  need  hospital  care  but  do  not  get  it  is 
because  the  general  hospitals  of  the  city  cannot  accommodate  them. 
Many  hospitals,  because  of  lack  of  money,  are  obliged  to  close  wards 
of  their  hospital  even  in  the  busiest  time  of  the  year.  The  Presby- 
terian Hospital,  for  example,  has  ioo  beds  lying  idle  for  this  reason, 
and  this,  too,  when  patients  are  being  refused  admission  constantly 
for  lack  of  room.  Again  in  some  sections  the  general  hospital 
accommodations  are  so  woefully  inadequate  that  people  are  obliged 
to  stay  at  home,  even  if  they  desired  to  go  to  a  hospital.  These 
reasons  here  given,  for  the  fact  that  more  people  ought  to  be  in 
general  hospitals,  are  but  a  few  of  the  many  which  might  be  given. 
In  view  of  these  facts,  it  is  safe  to  assume  that  the  present  rate  of 
hospital  attendance,  8.4%,  is  lower  than  what  it  ought  to  be.  Since, 
however,  it  is  impossible  to  obtain  data  upon  which  to  base  a  definite 
estimate  as  to  how  much  this  percentage  should  be  increased  to 
include  the  number  who  ought  to  be  in  hospitals  and  are  not  there, 
the  percentage  of  actual  hospital  attendance,  8.4,  has  been  used  as 
the  percentage  of  those  needing  hospital  treatment  in  Tables  XV 
to  XVIII.  It  can  thus  be  seen  that  the  computations  as  to  the 
present  number  of  people  needing  hospital  treatment  are  very 
conservative. 

With  this  percentage  as  a  basis,  the  attempt  was  first  made  in 
Manhattan  to  determine  what  is  the  actual  proper  bed  capacity  or 
how  many  persons  there  are  actually  in  each  hospital  district  need- 
ing hospital  care.  The  other  boroughs  of  the  city  were  subdivided, 
where  necessary,  with  similar  districts  and  the  same  method  applied 
as  in  Manhattan. 

Hospitals  in  Their  Own  Neighborhoods. 

A  fundamental  principle  upon  which  the  report  is  based  is  that 
hospitals  should  be  built  in  the  neighborhoods  from  which  their 
patients  come.  Two  conflicting  theories  of  hospital  location  here 
deserve  attention.  The  first  of  these  is  the  principle  just  stated, 
that  hospitals  should  be  built  where  the  people  who  will  use  them 
reside,  regardless  of  all  other  influences.  The  second  theory  goes 
on  the  assumption  that,  as  fresh  country  air  is  the  most  vital  essen- 
tial in  modern  medical  practice,  new  hospitals  should  be  built  in 
the  suburbs  and  rural  districts  about  the  city.  While  conceding 
the  high  scientific  value  of  this  latter  view,  it  must  be  borne  in 
mind  that  there  are  difficulties  in  the  way  which  render  it  imprac- 
ticable in  Greater  New  York.  This  theory  has  had  a  partial  vogue 
in  some  of  the  European  cities,  notably  Paris  and  Berlin,  but  the 
conditions  there  are  quite  different  from  those  in  New  York.  The 
phlegmatic  German  of  Berlin  or  the  ease-loving  Frenchman  of  Paris 
do  not  value  their  time  as  does  their  kinsman  of  New  York.     Here 


38 

"  time  is  money,"  and  the  loss  of  time  to  most  people  means  a  loss 
of  money  in  a  more  real  sense  than  it  does  to  the  European.  It  is 
mainly  for  this  reason  that  the  New  Yorker  would  object  to  being 
sent  out  of  the  city  or  at  a  distance  from  home  if  he  were  sick. 
It  would  mean  to  him  not  alone  the  separation  from  loved  ones, 
but  a  considerable  loss  and  expense  to  his  family  in  visiting  him. 
If,  after  all,  the  hospital  is  to  care  for  the  sick,  then  it  seems  reason- 
able to  suppose  that  it  should  be  built  where  it  will  be  easily 
accessible  to  the  sick. 

Home    Treatment. 

If  only  8.4%  of  the  sick  go  to  hospitals,  it  is  evident  that  at  least 
90%  must  be  treated  at  home.  The  advantages  of  home  treatment 
for  most  of  the  ordinary  diseases  are  evident,  provided  the  proper 
sanitary  arrangements  and  medical  facilities  can  be  procured  at 
home.  The  number  of  diseases  which  demand  hospital  treatment 
is  limited.  This  being  the  case,  it  is  manifestly  the  duty  of  the 
municipal  hospital,  as  well  as  of  the  private  one,  to  co-operate  in 
every  way  with  organizations  who  are  engaged  in  trying  to  improve 
the  standard  of  living  in  the  home.  In  this  field,  the  municipal  hos- 
pital has  a  very  definite  work.  Through  its  dispensary,  by  its 
nurses  and  doctors,  and  by  the  general  atmosphere  which  goes  out 
through  the  discharged  patients,  the  hospital  can  radiate  an  influ- 
ence which  should  go  far  to  lift  up  the  health  of  the  entire  com- 
munity. Thus,  with  the  hospital  near  at  hand  as  a  center 
not  only  for  the  cure,  but  also  for  the  prevention  of  disease,  the 
health  of  the  community  will  be  benefited  at  the  lowest  possible 
cost  to  the  patient  and  to  the  city. 

Method. 

In  computing  the  number  of  sick  in  a  given  area  needing  hos- 
pital care,  the  population  of  that  district  is  multiplied  by  .0221, 
since  it  was  found  from  Table  XIV  that  in  every  100  population 
2.21%  of  the  population  are  constantly  sick  of  some  form  of  disease 
which  might  be  treated  in  a  general  hospital.  Thus  the  number  of 
sick  in  each  district  (excluding  tuberculosis  and  contagious)  may  be 
obtained.  Of  that  number,  8.4%  is  taken  as  the  number  of  sick 
needing  treatment  in  general  hospitals.  By  this  method,  it  will  be 
seen  that  as  accurate  account  as  it  is  possible  to  obtain  of  the 
number  of  sick  needing  hospital  care  in  any  given  district  is 
obtained. 


39 


CHAPTER  IV. 

CONCLUSIONS. 

New  Hospitals  and  Their  Distribution. 

The  three  studies  of  hospital  population,  general  population,  and 
sickness  lead  to  the  general  conclusion  that  we  need  in  Greater 
New  York  500  additional  beds  for  present  emergencies,  and  that 
by  1920  we  will  need  2,900  more.  These  three  lines  of  data  do 
more,  however,  than  give  us  this  general  conclusion.  They  show 
how,  according  to  the  needs  of  the  different  districts,  this  large 
number  of  beds  should  be  distributed. 

We  consider  the  conclusions  in  two  parts,  first,  present  needs, 
and  second,  future  needs,  taking  up  under  each  head  the  needs  for 
the  various  boroughs  and  districts  separately. 

I.     PRESENT  NEEDS. 
1.  Manhattan. 

Considering  the  Borough  of  Manhattan  as  a  whole,  it  will  be 
seen  that  there  was  in  1905  an  excess  of  609  beds  over  what  was 
computed  as  the  proper  bed  capacity.  If  we  only  had  this  fact 
for  consideration  we  should  at  once  say  there  is  certainly  at  present 
no  need  for  hospitals  in  Manhattan.  And  this  would  be  true,  if 
people  would  go  from  all  over  Manhattan  to  where  the  excesses  in 
beds  are,  and  would  stay  away  from  where  there  was  a  marked  lack 
of  beds,  and  if  no  more  beds  were  needed  in  a  hospital  than  there 
were  patients  at  any  given  time.      (See  Table  XV  which  follows.) 

But  since  hospitals  are  built  chiefly  for  the  care  of  the 
sick,  and  since  the  sick  cannot  go  in  all  cases  for  miles  to  a 
hospital,  the  excess  of  609  beds  in  Manhattan  may  de- 
note a  need  for  more  hospital  accommodations.  It  does  not 
indicate  by  any  means  that  no  more  hospitals  are  needed  in  Man- 
hattan. It  does  indicate,  however,  that  if  all  the  hospitals  in  the 
borough  had  been  built  and  distributed  originally  according  to 
the  needs  of  the  population  of  the  various  districts,  our  present 
bed  capacity  in  Manhattan  would  then  be  in  excess  of  what  would 
be  needed.  But  since  hospitals  have  been  built  in  Manhattan,  fre- 
quently, wherever  a  philanthropic  donor  happened  to  have  an  unused 
site,  or  where  a  site  could  be  acquired  cheaply  and  with  no  regard 
to  the  needs  of  the  people  who  were  to  use  the  institutions,  the 
result  has  been,  as  before  stated,  that  we  have  large  districts  over- 
supplied  with  hospitals,  while  others  lack  their  proper  capacity. 
Hence  the  needs  of  this,  or  any  other  borough,  will  be  best  found 
by  looking  at  the  needs  of  the  various  districts  where  a  lack  of  beds 
is  seen  to  be  manifest,  rather  than  by  studying  the  needs  of  the 


40 


Table  XV. — Showing  Present  Bed  Capacity, 

Man 


Name  of  Ambulance 
District. 


Names  of  general 

hospitals  in 

district. 


(  St.  Gregory's 

House  of  Relief 4  House  of  Relief 

(  Trinityf 

Gouverneur I  Gouverneur 

I  Beth  Israel 

St.  Vincent's St.  Vincent's 

New  York New  York  Hospital 

f  Columbus 

New  York  Post  Graduate 
Bellevue I  Bellevue 

I  St.  Mark's 

I  St,  Francis* 

[  Polyclinic 

Flower Flower* 

(  German 

Presbyterian 4  Presbyterian 

'  Hahnemann 

(  St.  Elizabeth's 

Roosevelt ■<  Roosevelt 

(  French  Benevolent 

I  St.  Luke's ) 

J.  Hood  Wright ■<  J.  Hood  Wright J- 

(  Washington  Heights ) 

I  Mt.  Sinai ) 

Harlem •<  Harlem > 

(  Sydenham ) 


Totals,   Manhattan.  .  26  hospitals. 


Lincoln.. . . 
Lincoln  and  Lebanon. . .  4  Lebanon. . . 
St.  Francis. 


Fordham I  Philtnthropini 


Totals,  The  Bronx.  .5  hospitals. 


'opulation 

of 
district, 

Computed 

number 

daily 

sick 

Computed 
number 
needing 

hospitals 

1905. 

in 

district. 

care, 
1905. 

65.936 

1.457 

122 

265,343 

5.864 

493 

153.354 

3.389 

284 

127 ,065 

2,808 

235 

316,19s 


271 , 600 


6,988 


6 ,  002 


*Flower  Hospital  at  63d  St.  and  Avenue  A,  outside  its  own  ambulance  district. 

t  Hospital  closed  in  1907: 

JNo  longer,  in  1908,  used  for  general  hospital. 

§This  hospital  now  (in  1908)  belongs  in  Harlem  district. 


587 


III , 187 

2.457 

206 

182,252 

4,028 

338 

293,638 

6,489 

549 

330.337 

7.300 

613 

239.238 

5,287 

444 

2, 112,380 

46,43  7 

3.871 
THE 

168,517 

3.724 

313 

103,083 

2,  278 

191 

41 


Proper  Bed  Capacity,  and 
hattan. 


Beds  Needed  in  1920. 


Present  Number  B 
District,  Mar.  i, 

EDS  IN 
I906. 

Excess 
or  lack 
of  beds 

in 
i9°5-* 

By 

hospitals. 

Total. 

20  ) 

35  f 
28) 

83 

39 

90  1 

210 

283 

120  j 

125 

216 

980 

79 
50 
96 


245 
214 

81 

65) 
244  > 
150  J 
261 

58 

40 
480 

53 

65 


BRONX. 


500 

235 

500 

56 

14 


3»o 
205 


1,546 

100 

540 

459 
359 
598 


1,235 
70 


Population 


96 

30 

959 

106 
202 

90 

254 

154 


609 

922 

in 


1,305  801 

*Excess  denoted  in  black  face  type; 


65,936 

146 

321,065 

710 

171,756 
165,183 

380 
366 

411,052 

90S 

164,532 

364 

268,354 

593 

Known 
number  of 
Number  beds  in 

of  beds  1920, 

needed  in        including 
1920.  all  known 

additions. 

82 

35° 

425 
217 


180 
652 


381,727  844 
547,921  1,211 
396,660        877 


,931,288       6,399 

244,348  540 

195,858  433 


440,206  973 

lack  in  ordinary  type 


6,318 

1,235 
150 


1,385 


iixcess  or 
lack  of 
beds  in 
1920.* 


64 
360 

45 
149 

1,614 


59 

292 

781 
29 

81 

665 

283 

412 


42 

borough  as  a  whole.  On  account  of  this  fact  of  poor  distribution 
of  hospitals,  it  is  certainly  a  conservative  estimate,  as  before  stated, 
to  allow  that  one-tenth  of  the  entire  bed  capacity  of  the  city  would 
be  more  used  if  it  were  better  located. 

Again,  it  must  be  noted  that  the  figures  at  this  point  are  com- 
puted on  the  actual  number  of  sick  needing  hospital  treatment  in 
the  various  districts  of  the  city.  No  allowance  is  made  for  any 
needed  excess  in  bed  capacity,  such  as  would  be  required  in  any 
individual  hospital  or  group  of  hospitals.  The  reason  for  this  has 
been  discussed  on  page  23,  Chapter  I.  Allowance  must  always 
be  made  for  extra  beds  that  cannot  be  used  on  account  of  differ- 
ences in  sex,  disease,  age,  etc.  It  is  estimated  on  a  most  conserva- 
tive basis  that  one-tenth  of  the  bed  capacity  of  any  hospital,  or 
group  of  hospitals,  is  always  kept  in  reserve,  or  in  excess  of  the 
number  of  patients. 

The  computations  in  this  table  and  the  tables  for  the  other  bor- 
oughs are  based  on  the  population  of  1905.  It  is  impracticable  to 
attempt  to  distribute  the  population  of  the  city  by  small  districts 
for  so  short  a  period  as  three  years.  Consequently  the  figures  of 
1905  are  used  with  corrections  where  necessary,  on  account  of 
change  in  hospital  conditions,  up  to  January  1,  1908. 

Thus,  by  taking  in  account  these  two  factors,  from  which  it  will 
be  seen  that  at  least  one-fifth  of  the  bed  capacity  of  the  city  might 
be  in  excess  of  the  number  of  patients,  it  will  be  seen  that  a  com- 
puted excess  of  609  beds  for  the  Borough  of  Manhattan  is  not 
indicative  at  all  of  no  need  for  more  beds.  It  indicates  rather  that 
about  200  beds  are  needed,  a  conclusion  which  is  verified  by  a  closer 
study  of  the  various  districts  of  the  city. 

Methods  of  Hospital  Distribution. 

But  before  taking  up  a  detailed  study  of  the  needs  of  the  bor- 
ough, we  must  consider  how  the  bed  capacity  of  any  given  section,, 
district,  or  borough  can  best  be  distributed.  Manifestly  there  are 
but  two  ways  in  which  this  can  be  done : 

(1)  By  building  local  hospitals  of  the  size,  ascertained  by  com- 
putation, required  to  meet  the  needs  of  the  district.  This  is  the 
method,  so  far  as  any  policy  at  all  has  been  pursued,  upon  which 
both  municipal  and  private  hospitals  have  hitherto  proceeded.  If 
a  given  district  was  seen  to  be  in  need  of  hospital  accommodations, 
a  hospital  of  from  50  to  200  beds  was  at  once  erected.  This 
method  has  its  advantages,  but  it  has  also  certain  disadvantages 
over  against  the  other  method  of  distribution.  Before  considering 
the  relative  merits  of  this  method,  let  us  consider  the  other  way  of 
distributing  the  needed  bed  capacity  of  the  borough. 

(2)  A  second  method  is  by  establishing  ambulance  stations  in 
the  district  where  a  lack  of  bed  capacity  is  shown ;"  and  then  by 


43 

building  the  additional  beds  required,  not  in  the  immediate  neigh- 
borhood in  which  the  lack  of  beds  is  indicated,  but  to  one  large 
general  hospital  which  should  supply  the  needs  of  the  entire  bor- 
ough. By  an  ambulance  station,  as  opposed  to  a  local  hospital 
on  the  one  hand,  or  a  general  hospital  on  the  other,  we  mean  a 
small  hospital  of  not  more  than  ten  beds.  The  Bradford  Street 
Hospital  in  East  New  York  is  a  fair  illustration  of  this  type  of  in- 
stitution. The  House  of  Relief  on  Hudson  Street,  while  consider- 
ably larger  than  the  above  suggested  figures,  is  also  a  type  of  this 
institution. 

The  ambulance  station  has  peculiar  advantages  over  the  local  hos- 
pital, as  a  means  of  distributing  the  bed  capacity  of  the  city  in  the 
districts  where  it  is  needed.     Among  its  advantages  may  be  classed : 

(a)  The  economy  with  which  such  an  institution  can  be  run  is 
evident.  The  ambulance  station  is  not  an  independent  hospital. 
It  is  part  of  its  parent,  the  general  hospital.  As  such,  it  serves 
only  to  relieve  the  emergency  needs  of  the  community  in  which 
it  is  located.  The  average  length  of  stay  in  such  an  institution  is 
from  four  to  five  days.  Cases  which  would  require  longer  treat- 
ment would  be  transferred  to  the  general  hospital  of  which  the 
ambulance  station  is  a  part.  Thus  it  will  be  seen  that  the  ambu- 
lance station,  while  having  in  itself  a  limited  bed  capacity,  is  never- 
theless allied  with  the  best  resources  which  hospital  management 
can  procure. 

(b)  A  second  advantage  of  the  ambulance  station  is  the  ease  with 
which  it  can  be  moved  or  abandoned.  It  is  comparatively  inexpen- 
sive to  fit  up  an  existing  building  or  build  a  small  new  one  for 
these  purposes;  and  when  such  station  should  have  outlived 
its  usefulness,  it  can  either  be  moved  or  abandoned  with  little  loss. 

(c)  A  third  advantage  of  the  ambulance  station  is  that  in  neigh- 
borhoods where  it  is  not  sure  that  a  local  hospital  would  be  required, 
an  ambulance  station  would  soon  find  out  whether  there  was  definite 
need  for  a  larger  institution.  The  ambulance  station  thus  becomes 
a  local  hospital  in  embryo. 

(d)  The  ambulance  station  has  a  further  advantage  as  above 
indicated,  in  that  it  affords  quick  relief  in  case  of  sickness  or  acci- 
dent to  the  neighborhood  in  which  it  is  located,  and  at  the  same 
time  gives  direct  connection  with  the  medical  staff  and  with  the 
medical  appliances  of  the  general  hospital. 

The  advantages  of  the  general  hospital  of  1,000  beds  over  against 
the  small  local  hospital  of  from  ioo  to  300  beds  are  apparent.  It 
is  only  in  the  larger  institution,  where  sufficient  numbers  and  varie- 
ties of  cases  are  received,  that  advanced  methods  of  treatment  can 
be  afforded.  In  a  small  local  hospital,  where  the  cases  of  any  par- 
ticular disease  are  few  in  number,  the  attraction  to  specialists  is 
comparatively  small.  Consequently  the  advantages  which  the  larger 
institutions  give  are  apparent. 


44 

In  the  distribution,  then,  of  the  hospital  accommodations  both  for 
the  present  and  for  the  future  we  shall  use  both  methods  above 
mentioned.  The  particular  character  of  the  district  needing  hos- 
pital accommodations  will  determine  whether  an  ambulance  station 
or  a  local  hospital  is  required,  i.  e.,  whether  it  is  an  advantage  to 
build  the  required  number  of  beds  in  the  neighborhood  where  the 
lack  is  shown,  or  whether,  on  the  other  hand  it  is  an  advantage  to 
build  simply  a  relief  station  there  and  place  the  additional  number 
of  beds  needed  in  some  large  central  institution.  This  principle  will 
govern  us  in  the  distribution  of  hospitals  and  hospital  accommoda- 
tions throughout  this  report. 

St.  Vincent's. — Of  the  ten  ambulance  districts  in  Manhattan, 
four  show  an  excess  on  March  i,  1906,  over  the  proper  bed 
capacity  on  that  date,  as  indicated  by  Table  XV.  In  the  St.  Vin- 
cent's hospital  district,  while  there  is  only  this  one  hospital,  it  is 
computed  to  have  an  excess  of  96  beds  over  what  is  needed  for 
the  district.  On  March  1,  1906,  the  St.  Vincent's  Hospital  had 
275  patients  and  380  beds,  an  excess  of  95  beds.  (See  Table  IX,  p. 
80.)  This  hospital  stands  in  a  neighborhood  whose  population  is 
stationary.  If  it  did  not  draw  very  largely  from  the  city  as  a  whole 
through  its  religious  affiliations,  it  would  have  many  more  vacant 
beds  than  now. 

Middle  and  Upper  East  Side. — In  the  Bellevue  ambulance  district 
an  excess  of  959  beds  is  given.  In  this  district,  whose  actual  popu- 
lation is  very  large,  there  are  in  1908,  five  general  hospitals,  con- 
taining in  all  over   1,500  beds. 

In  fact,  more  than  one-third  of  the  bed  capacity  of  Manhattan 
is  centered  in  this  district.  Of  course  the  use  of  Bellevue  Hospital 
as  a  receiving  station  for  all  cases  considered  unsuitable  by  the 
private  hospitals  makes  it  necessary  for  this  institution  to  have  a 
large  enough  capacity  for  the  work.  But,  even  with  Bellevue 
omitted  from  the  hospitals  of  the  district,  the  other  four  would  leave 
but  a  very  slight  lack  of  bed  capacity.  And  this  is  more  marked 
when  we  consider  that  Bellevue  Hospital  has  a  very  active  ambu- 
lance service,  covering  its  own  large  territory,  and  that  thus  it  gets 
about  30%  of  its  patients. 

An  excess  of  202  beds  is  shown  in  the  Presbyterian  Hospital 
district.  The  three  large  hospitals  of  this  district,  together  with 
Flower  Hospital,  just  south  of  this  territory,  easily  fill  all  the  needs 
of  the  Upper  East  Side. 

The  hospital  needs  of  the  East  Side  in  Harlem  are  also  met,  as 
here  an  excess  of  154  beds  is  computed.  The  hospitals  of  this  dis- 
trict and  the  Presbyterian  and  Bellevue  districts  contain  60%  of 
the  bed  capacity  of  the  Borough  of  Manhattan.  It  would  seem, 
therefore,  in  view  of  these  facts,  that  no  more  hospitals  are  needed 
for  present  needs  on  the  East  Side  above  Houston  street. 


45 

Two  sections  of  the  city,  however,  are  in  need  of  hospital 
accommodations  at  once. 

Lower  Manhattan. — The  first  of  these  is  the  lower  end  of  the 
island  of  Manhattan,  including  the  first  six  wards  of  the  city,  or 
the  House  of  Relief  ambulance  district,  and  also  a  portion  of  the 
lower  East  Side,  or  the  Gouverneur  ambulance  district.  According 
to  Table  XV  a  lack  of  39  beds  is  shown  in  the  first-mentioned 
section  and  283  in  the  second,  which  adjoins  the  House  of  Relief's 
territory  on  the  north.  The  needs  of  the  first-named  district  are 
increased  in  1908  by  the  closing  of  the  Trinity  Hospital. 

Considering  then,  first  of  all,  the  territory  in  the  House  of  Relief's 
district,  it  seems  as  if  there  is  need  here  for  an  ambulance  station  of 
at  least  8  beds  to  meet  the  immediate  needs  of  the  district.  The 
territory  in  this  district  is  that  below  Canal  and  Catherine  streets,  or 
the  extreme  lower  end  of  the  island  of  Manhattan.  This  territory 
has  a  resident  population  of  but  65,000,  which  seems  to  be  about 
stationary.  The  daytime  population,  however,  is  very  large  and 
numbers  at  least  a  half  million.  This  population  is  constantly  on 
the  increase.  Every  year  sees  more  clerks,  more  business  men, 
more  mechanics,  more  business  and  traffic  of  every  kind  within  this 
territory.  There  are  in  1908  but  two  small  general  hospitals  located 
in  this  district,  the  House  of  Relief,  with  a  capacity  of  42  beds,  and 
the  St.  Gregory's,  with  40,  making  altogether  82  beds.  There  are 
more  accidents  here  than  in  any  other  district  in  Greater  New  York, 
and  the  hospital  work  of  this  district  is  largely  of  an  ambulance 
character.  In  the  year  1905  the  House  of  Relief  ambulance 
answered  5,164  calls,  or  a  daily  average  of  14.1.  This  hospital  alone 
had  11.6%,  or  nearly  one-eighth  of  the  total  ambulance  calls  of 
Manhattan  for  1905,  i.  e.,  a  hospital  with  .7  of  1%  of  the  hospital 
beds  of  the  borough  was  called  upon  to  answer  11.8%  of  the 
ambulance  calls.  The  St.  Gregory's  Hospital,  without  a  regularly 
assigned  district,  answered  over  1,000  private  calls.  The  three 
ambulance  district  hospitals  below  14th  street,  the  House  of  Relief, 
St.  Vincent's,  and  Gouverneur,  answered  in  1905  40%  of  all  the 
ambulance  calls  in  the  borough  for  1905.  When  it  is  considered 
that  below  Canal  street  there  is  resident  but  3.1%  of  the  popula- 
tion of  Manhattan,  and  below  14th  street  but  31.5%,  it  can  be  seen 
how  largely  this  business  papulation  needs  hospital  service.  Of 
the  calls  answered  by  the  House  of  Relief  ambulance,  1,334,  or 
about  one-quarter,  were  transferred  to  Bellevue  without  being 
brought  to  the  hospital.  One  thousand  four  hundred  and  forty-three 
of  the  3,387  patients  treated  in  the  wards  in  1905  were  patients 
admitted  with  surgical  injuries.  Eighty-four  per  cent,  of  the  entire 
work  done  in  the  wards  of  this  hospital  was  for  cases  brought  in 
on  emergency  calls  by  the  ambulances.  When  it  is  considered  that 
the  average  stay  of  the  patients  in  this  hospital  for  1905  was  but 


46 

44  days,  it  can  be  seen  at  once  what  the  character  of  the  work  done 
here  is.  It  will  be  seen  then  that  there  are  at  present  67  additional 
beds  required  for  the  present  needs  of  this  district  according  to  the 
methods  of  computation. 

The  needs  of  the  House  of  Relief's  territory  are  emphasized  when 
considered  in  connection  with  those  of  the  Gouverneur  district  on  the 
northeast.  In  this  district  a  lack  of  283  beds  is  shown.  (See  Table 
XV,  p.  41.)  With  the  completion  of  the  additions  now  in  progress 
on  the  Gouverneur  Hospital  and  those  about  to  be  made  on  the  Beth 
Israel,  this  figure  will  be  reduced  to  about  200  or  less.  During  the 
past  two  years  repeated  efforts  have  been  made  by  private  charity 
to  start  new  hospitals  in  this  section.  The  State  Board  of  Charities, 
while  admitting  the  evident  need  for  additional  hospital  accommoda- 
tions in  this  neighborhood,  has  refused  charters  to  all  applicants, 
because  of  insufficient  financial  backing.  The  new  Mt.  Moriah 
Hospital,  now  in  building  is  not  yet  incorporated.  This  demand  for 
more  hospitals  here  is  impressed  upon  one  who  sees  the  constantly 
crowded  condition  of  the  two  general  hospitals  here.  It  is  further 
stated  by  the  social  workers  of  this  district  that  many  more  people 
would  go  to  a  hospital  if  there  were  another  one  nearby,  and  they 
would  not  run  the  likelihood  of  being  transferred  to  Bellevue. 

Accordingly,  the  needs  of  the  House  of  Relief  ambulance  district, 
together  with  those  of  the  Gouverneur  district,  point  to  the  immedi- 
ate necessity  for  an  ambulance  station  of  8  beds,  the  remaining  beds 
needed  in  this  district  to  be  centered  in  Bellevue  Hospital.  A  station 
here  would  be  easily  accessible  to  the  eastern  waterfront  as  well 
as  to  the  great  manufacturing  establishments  and  newspaper  offices 
of  this  district.  The  largest  percentage  of  the  calls  of  the  House 
of  Relief  come  from  the  Chinatown  section  in  the  6th  ward,  to 
which  a  hospital  located  as  suggested  would  be  easily  accessible. 
Such  a  station,  moreover,  would  furnish  sufficient  relief  to  the 
Gouverneur  district  so  as  to  meet  all  the  present  needs  of  this  com- 
munity. Within  a  five  minutes  run.  an  ambulance  from  this  sug- 
gested station  could  reach  the  crowded  residential  districts  on  the 
north  as  well  as  the  packed  business-filled  canons  of  Nassau  and 
Wall  streets  on  the  south.  These  many  reasons  urge  the  immediate 
erection  of  an  ambulance  station  in  the  lower  end  of  Manhattan. 

Middle  West  Side. — Another  section  of  the  city,  also,  is  in  need 
of  additional  hospital  accommodations  to  meet  present  needs.  This 
is  the  Middle  West  Side,  comprising  chiefly  the  Roosevelt  ambulance 
district,  or  the  territory  between  20th  and  86th  streets  west  of 
Sixth  avenue.  A  lack  of  90  beds  is  computed  for  this  district  (see 
Table  XV),  which  lack  would  be  increased  by  at  least  60  more 
when  it  is  noted  that  the  St.  Elizabeth's  Hospital  is  really  a  private 
hospital  for  pay  patients  only.  As  in  the  lower  Manhattan  section, 
so  in  the  Middle  West  Side,  the  work  of  the  large  hospital  of  the 


47 

district  (the  Roosevelt)  is  chiefly  that  brought  in  by  the  ambulance. 
In  fact  88%  of  the  entire  work  done  in  the  Roosevelt  Hospital  in 
1905  was  brought  in  by  the  ambulances.  This  hospital  is  without 
doubt  one  of  the  busiest  hospitals  in  the  city.  Hundreds  of  patients 
are  turned  away  every  year  for  lack  of  room.  This  is  true  even 
when,  as  in  1905,  nearly  2,000  cases  were  transferred  to  Bellevue 
Hospital,  many  of  them  because  of  insufficient  hospital  accommo- 
dations in  the  Roosevelt  Hospital. 

Some  of  the  needs  of  the  Roosevelt  ambulance  district  might  be 
met  by  a  redisricting  of  this  territory  on  the  West  Side,  but  even 
then  there  would  still  remain  the  fact  that  there  are  in  this  district 
at  least  550  sick  needing  general  hospital  care,  with  less  than  400 
beds  that  can  be  depended  upon  to  care  for  them.  The  fact  that 
the  Roosevelt  district  contains  what  will  be  when  completed  the 
largest  railway  terminal  in  the  world,  gives  additional  force  to  the 
argument  for  a  new  hospital  in  this  vicinity.  Although  there  is 
little  probability  of  a  rapid  increase  in  resident  population  on  the 
Middle  West  Side,  there  is  every  indication  that  the  business  popu- 
lation who  throng  the  streets  in  the  daytime  will  show  a  large 
increase  over  the  present  condition. 

With  all  these  facts  emphasizing  the  need  for  more  hospital  beds 
on  the  Middle  West  Side,  it  is  suggested  that  an  ambulance  station 
of  8  beds  be  built  in  the  vicinity  of  40th  or  45th  streets  and  9th  and 
10th  avenues.  An  institution  here  would  supply  all  the  needs  of  the 
middle  district  and  would  leave  the  Roosevelt  Hospital  free  to  do 
a  larger  work  in  the  growing  population  to  the  north. 

Upper  West  Side. — One  further  section  of  Manhattan  demands 
special  attention  here.  That  is  the  Upper  West  Side,  comprising 
largely  the  J.  Hood  Wright  and  Washington  Heights  districts.  It 
wili  be  noted  that,  in  Table  XV,  a  lack  of  254  beds  is  shown. 
About  60  beds  from  this  number  should  be  deducted  on  account  of 
the  new  Red  Cross  Hospital  which  opened  October  1,  1907,  at  99th 
street  and  Central  Park  West.  St.  Luke's  Hospital  has  increased 
its  capacity  to  298  since  1905.  The  needs  of  this  large  territory 
have  been  more  than  met  by  the  opening  of  the  new  Harlem  Hos- 
pital, with  100  additional  beds,  on  the  boundaries  at  the  corner  of 
136th  street  and  Lenox  avenue.  The  moving  of  the  Philanthropin 
Hospital  into  this  district  from  the  Upper  Bronx  has  added  18  beds. 
Thus  the  apparent  needs  of  this  district  are  met,  and  it  does  not 
seem  as  if  more  hospitals  are  needed  here  for  present  use. 

Summary. — The  present  needs  for  Manhattan  may  be  summed 
up,  then,  by  stating  the  need  for  an  ambulance  station  of  8  beds  in 
the  Lower  Manhattan  Section  near  Chambers  street  and  Park  Row ; 
and  for  another  of  similar  size  in  the  Middle  West  Side  section,  be- 
tween 40th  and  45th  streets  and  9th  and  10th  avenues. 


48 

2.  The  Bronx. 

The  present  (1908)  bed  capacity  of  the  Bronx,  1,265  beds,  is  now 
well  in  excess  of  what  is  needed  to  meet  all  the  existing  needs.  With 
three  of  the  largest  hospitals  in  the  city  in  the  southern  Bronx,  and 
a  fine  new  city  institution  (Fordham  Hospital)  in  the  northern 
Bronx,  all  the  present  needs  seem  to  be  met.  According  to  the 
method  of  computing  the  hospital  needs,  only  504  persons  are  found 
to  be  actually  needing  hospital  care,  showing  an  excess  of  801  beds. 
This  excess  is  due  largely  to  the  fact  that  far-sighted  hospital 
managers  are  already  beginning  to  build  for  the  future  needs  of 
this  section,  and  for  a  second  reason,  because  the  hospitals  in  the 
Bronx  are  accommodating  a  large  number  of  patients  from 
Manhattan. 

3.  Brooklyn. 

As  mentioned  in  the  discussion  of  the  hospital  population  in 
Brooklyn,  most  of  the  hospitals  here  are  located  in  the  old  town, 
while  the  outlying  sections  of  East  New  York,  Flatbush,  Flatlands, 
Bushwick,  and  Bay  Ridge  have  inadequate  accommodations.  The 
city  of  Brooklyn  is  about  twelve  miles  long  from  north  to  south, 
and  about  seven  miles  broad  from  east  to  west.  Within  this  area 
the  hospital  population  centers  inside  of  a  circle  with  a  two  and  a 
half  mile  radius.  It  will  thus  be  seen  that  there  are  many  sections 
from  which  patients  are  obliged  to  travel  in  an  ambulance  or  other- 
wise from  three  to  six  miles  to  a  hospital.  It  is  partly  because  of 
this  congestion  of  hospitals  that  the  Borough  of  Brooklyn  as  a 
whole  shows  an  excess  of  410  beds  (see  Table  XVI  which  follows), 
while  some  sections  of  the  city  are  in  immediate  need  of  additional 
hospitals.  The  same  reasons  which  account  for  the  excess  in  Man- 
hattan have  added  weight  also  here. 

Heights  and  Red  Hook. — Considering  the  three  districts  in  which 
excess  of  bed  capacity  is  computed,  we  note  that  in  the  Heights 
and  Red  Hook  district  there  are  now  571  beds,  while  the  number 
of  sick  in  that  district  needing  them  is  but  384,  making  an  excess 
of  187  beds.  This  district  claims  the  two  largest  private  hospitals 
in  Brooklyn,  and  will  have  an  increased  number  of  beds  when  the 
remodelling  of  the  Long  Island  College  Hospital,  now  in  progress, 
is  completed.  It  is  one  of  the  few  sections  of  Brooklyn  where 
population  is  about  stationary,  comprising  as  it  does  much  of  the 
very  oldest  residential  section  of  the  city.  While  some  increase  in 
laboring  population  has  been  felt  in  the  southern  part  of  Red  Hook, 
this  has  been  very  slight  in  the  past  fifteen  years.  So  there  seems 
to  be  no  immediate  need  here  for  more  hospital  accommodations. 

Flatbush. — The  excess  of  beds  in  the  Flatbush  section  of  Brooklyn 
(829)  is  due  largely  to  the  fact  that  this  district,  on  January  1, 
1908,  contained  six  hospitals  aggregating  over  1,200  beds,  or  nearly 
50%  of  the  entire  capacity  of  the  city,  while  the  sick  population  calls 


49 

for  but  414  beds.  This  district,  however,  like  the  Bellevue  district 
of  Manhattan,  has  a  large  general  hospital  which  receives  patients 
from  all  over  the  borough.  But  even  when  the  bed  capacity  of  the 
Kings  County  Hospital  is  deducted,  there  will  still  be  found  an 
excess  of  about  200  beds  in  the  district.  It  is,  then,  no  assumption 
to  say  that  Flatbush  has  far  more  hospital  beds  than  it  needs  for 
present  purposes  in  its  own  district. 

North  Brooklyn. — Considering  now  some  of  the  sections  of 
Brooklyn  where  there  is  a  present  need  for  more  hospital  accom- 
modations, we  note  that  the  two  districts  of  Bedford  and  Williams- 
burg and  Bushwick  combined  give  a  lack  of  over  550  beds.  It 
will  also  be  noted  that  the  district  in  which  the  Cumberland  Street 
Hospital  is  located  shows  an  excess  of  121  beds.  (See  Table  XVI.) 
If,  however,  the  Cumberland  Street  Hospital,  which  supplies  the 
need  of  Bedford  largely,  were  taken  from  this  Prospect  Heights 
district,  we  would. have  an  excess  here  also.  There  are,  thus,  without 
doubt  a  large  number  of  sick  in  the  northern  part  of  Brooklyn  who 
do  not  go  to  a  hospital  because  there  is  none  convenient. 

This  territory  is  fast  developing  a  tenement-house  population 
such  as  that  of  the  lower  East  Side  of  New  York.  Across  the  Wil- 
liamsburg bridge  have  come  within  the  last  three  years  a  large  num- 
ber of  Jews  who  have  settled  in  this  territory  in  Brooklyn,  bringing 
with  them  their  habits  and  customs  of  the  lower  East  Side  of  Man- 
hattan. As  noted  in  Chapter  II,  page  29,  in  the  study  of  popula- 
tion, this  territory  contains  the  only  section  of  Brooklyn  (Ward  16) 
which  has  a  density  of  over  two  hundred  persons  per  acre.  There  is 
little  doubt  but  the  whole  district  will  increase  in  population  and 
in  density.  In  this  North  Brooklyn  territory  is  centered  now  nearly 
one-half  the  entire  population  of  the  borough,  with  less  than  one- 
third  of  the  entire  number  of  hospital  beds.  North  of  Flushing 
avenue  and  Broadway  is  a  territory  which  has  an  area  equal  to 
more  than  one-third  of  the  entire  area  of  the  Borough  of  Manhattan. 
It  has  a  population  equal  to  more  than  one-fifth  of  that  of  the  entire 
Borough  of  Manhattan.  Yet  it  has  but  five  hospitals,  with  an 
aggregate  capacity  of  464  beds,  or  equal  to  less  than  one-tenth  of 
the  bed  capacity  of  Manhattan.  These  facts  speak  loudly  the  need 
for  more  hospital  accommodations  here. 

On  March  1,  1906,  the  eight  hospitals  of  this  district  were 
crowded  to  within  about  one-tenth  of  their  capacity,  and  two  of 
them  had  more  patients  than  beds.  (See  Table  X.)  The  Cumber- 
land Street  Hospital  conducts  one  of  the  most  exacting  services  of 
any  hospital  in  the  city,  and  yet  it  is  frequently  the  case  that  from 
one  to  twenty-five  or  more  patients  are  compelled  to  sleep  on  the 
floor  and  many  more  refuse  to  go  to  the  hospital  at  all  because  of 
lack  of  room.  That  the  Cumberland  Street  Hospital  is  overcrowded, 
is  evidenced  by  the  figures  shown  in  Table  X,  where  on  March  1st 
the  number  of  patients  was  205,  while  the  bed  capacity  was  but  200. 


5° 


Name  of  District 
with  Ward 
Equivalents. 


Table  XVI. — Showing  Present  Bed  Capacity, 

Brook 


Names  of  general 

hospitals  in 

district. 


The  Heights    (Wards  i,  J  Long  Island  College. . . 

2,  3,  4,  5,  6),  and  Red  I  St.  Peter's 

Hook  (Wards  io,  12). 

Bedford   (Wards   7,    13,  j  Brooklyn,  E.  D 

19,  21) I  Williamsburgh 

Prospect  Heights  (Wards  I  Cumberland  Street. . .  . 

9,  11,  20,  22) -\  Brooklyn 

( Methodist 

Williamsburgh     (Wards 

14,    i5;    16,    17),  and  I  St.  Catherine's J 

Bushwick  (Wards    18,  -<  German > 

27,  28) f  Bethany ) 

East  New  York     (Ward  I  Bradford  Street. .  „ I 

26) 1  Lutheran ". f 

f  St.  John's ] 

i  St.  Mary's I 

Flatbush  (Wards  23,  24,  I  Bushwick ! 

25,  29,  32) I  Kings  County ! 

I  Swedish I 

L  Jewish* J 

Bay   Ridge    (Wards    8,  j  Norwegian^.  .......  . 

3°'  3     /  Samaritan 


Totals 21  General  hospitals. 


Population 

of 

district, 

Computed 

number 

daily 

sick 

Computed 
number 
needing 
hospital 

1905. 

in 

district. 

care  in 
1905. 

206, 929 

4.572 

384 

174,922 

3,865 

356,439 

7.877 

94,149 

2  ,080 

223,053 

4.93o 

*The  Jewish  Hospital,  though  opened  December,  1906,  is  counted  in  present  capacity. 


5i 


Proper  Bed  Capacity,  and  Beds  Needed  in  1920. 
lyn. 


Present  Number  Gen- 
eral Hospital  Beds  in 
District. 

Excess 

or  lack 

of  beds 

in 

i9°5-t 

Population 
in 
1920. 

Number 

of  beds 

needed  in 

1920. 

Known 
number  of 

beds  in 
1920, 

including 
all  known 
additions. 

Excess  or 

lack  of 

beds  in 

1920. t 

By 

hospitals. 

Total. 

250  1 
321  1 

57i 

187 

267, 216 

59i. 

641 

50 

38  \ 

75  1 

113 

213 

327,974 

725 

170 

555 

200  ) 
165  \ 
100  ) 
196 
120  > 
35  ) 

465 
35i 

101 

310 

243,348 
521,320 

538 
1,152 

655 
502 

117 

650 

54  1 

62 

112 

170,810 

378 

135 

243 

84l 
230  1 

38 

631  1 

1,243 

829 

464,799 

1 ,026 

1,480 

454 

60  | 

- 

200  J 

94) 

25) 

127 

102 

289,797 

641 

217 

424 

2,932 

410 

2 , 284, 264 

5,051 

3,800 

1,251 

tExcess  denoted  in  black  face  type;  lack  in  ordinary  type. 


52 

The  reports  of  the  New  York  City  Visiting  Committee  also,  as  well 
as  the  reports  of  the  superintendent  of  the  Cumberland  Street 
Hospital,  have  constantly  spoken  of  the  overcrowding  of  this  insti- 
tution and  have  consistently  recommended  an  addition. 

The  present  investigation,  however,  leads  to  the  conclusion  that 
it  would  be  a  better  policy  to  build  the  proposed  addition  to  the 
Cumberland  Street  Hospital  in  the  form  of  an  ambulance  station  of  8 
beds  somewhere  to  the  north  of  that  institution  in  the  northern  part 
of  the  21st  ward,  or  the  southern  part  of  the  18th  or  19th  wards. 
A  station  located  here  would  serve  not  only  as  a  relief  to  the  Cum- 
berland Street  institution,  but  would  be  located  in  such  a  manner 
as  to  be  easily  accessible  to  the  population  to  the  north  and  to  the 
more  immediate  neighborhood.  It  will,  moreover,  be  advantageously 
located  when  this  district  has  so  increased  in  population  that  the 
Cumberland  Street  Hospital  will  be  almost  inaccessible  to  the  resi- 
dents of  the  16th,  18th,  and  19th  wards. 

The  present  growing  needs  of  this  North  Brooklyn  district,  how- 
ever, demand  more  than  one  ambulance  station  of  eight  beds.  As 
indicated  above,  this  section  shows  a  lack  of  over  500  beds.  Rather 
than  distribute  this  number  of  beds  in  several  small  hospitals,  it 
seems  a  better  plan  to  erect  in  this  territory  a  large  general  hos- 
pital, and  distribute  the  bed  capacity,  so  far  as  is  needed,  in  ambu- 
lance stations.  It  is  accordingly  suggested  that  a  general  hospital 
of  500  beds  be  built  in  the  eastern  end  of  North  Brooklyn  district, 
preferably  in  the  28th  ward,  near  Decatur  and  Irving  avenue. 
Such  a  hospital,  together  with  an  ambulance  station  as  indicated 
above,  would  meet  all  the  present  needs  of  this  growing  district, 
and  provide  as  well  a  way  for  the  enlarging  of  hospital  accommoda- 
tions for  future  needs. 

South  Brooklyn. — Another  district  of  Brooklyn  which  is  now  in 
need  of  more  hospitals  is  South  Brooklyn,  or  the  territory  south  of 
Prospect  Park  and  Greenwood  Cemetery,  comprising  the  Bay  Ridge 
Local  Improvement  District.  As  will  be  noted  in  Table  XVI,  102 
additional  beds  are  needed  here.  A  word  as  to  the  distances  between 
hospitals  in  the  district  will  show  that  this  is  not  an  extravagant 
number  of  beds.  Between  the  Norwegian  Hospital,  on  Fourth  avenue 
and  46th  street,  and  the  proposed  Coney  Island  Hospital  on  Ocean 
Parkway,  there  is  a  distance  of  about  five  miles.  Westward  and 
northward  the  nearest  hospital  is  between  three  and  four  miles. 
The  ambulances  of  the  Norwegian  Hospital  often  make  runs  of  six 
miles  south  to  Bath  Beach,  Gravesend  and  Bensonhurst.  To  the 
east  and  to  the  northeast  of  Coney  Island  Hospital  there  is  no  hos- 
pital until  the  Bradford  Street  is  reached,  "a  distance  of  about 
seven  miles.  The  Kings  County  Hospital,  almost  north  of  the 
new  Coney  Island  Hospital,  is  about  five  miles  away.  Bearing  in 
mind  that  this  district,  including  the  30th,  31st,  and  32d  wards, 
is  the  most   rapidly   growing   section   of  Brooklyn,  -the  need   for 


53 

additional  hospital  accommodations  here  can  be  seen  at  once.  The 
superintendent  of  the  Norwegian  Hospital,  Rev.  E.  C.  Tollefsen, 
gave  as  his  opinion  that  a  hospital  between  their  institution  and  the 
Coney  Island  Hospital  with  ioo  beds  should  be  built  almost  imme- 
diately. He  said  that  he  thought  such  a  hospital  would  be  full 
within  a  year. 

Taking  into  consideration  the  fact  that  the  new  subway  terminal 
in  Brooklyn  is  to  be  at  the  lower  end  of  Prospect  Park,  there  is 
little  doubt  that  the  territory  adjoining,  known  as  Kensington  and 
the  Borough  Park  district,  will  increase  very  rapidly  within  the  next 
fifteen  years.  Already  real  estate  is  rising  at  a  very  rapid  rate 
and  many  buildings  are  going  up  in  this  territory.  An  ambulance 
station  located  here  would  serve  as  a  relief  to  the  overcrowded  Kings 
County  Hospital  on  the  east  end,  and  to  the  growing  population  of 
this  territory  on  the  south  and  west.  This  station  should  be  located 
preferably  in  the  Borough  Park  section  south  of  Greenwood  Ceme- 
tery. It  should  be  built  at  once  for  8  beds,  although  land  should 
be  secured  now  when  it  can  be  done  at  a  reasonable  price  for  the 
building  of  a  local  hospital  of  two  or  three  hundred  beds. 

East  New  York. — In  the  East  New  York  district  112  beds  are 
computed  as  necessary.  This  need  is  amply  met  by  the  provision 
of  the  Department  of  Charities  to  build  a  new  hospital  of  100  beds 
on  Dumont  street,  facing  Linton  Park,  which  it  is  urged  be  started 
at  once. 

Summary  for  Brookyn. 

Summarizing  the  situation  for  Brooklyn's  present  needs,  we  find, 
then,  that  two  ambulance  stations,  one  in  North  and  one  in  South 
Brooklyn  are  needed,  and  besides  these,  a  general  hospital  in  North 
Brooklyn.  This  makes  on  all  a  little  over  500  beds  required  to  meet 
the  present  needs  of  Brooklyn. 

4.  Queens. 

The  bed  capacity  of  Queens  Borough  is  at  present  amply  ade- 
quate for  the  hospital  needs.  (See  Table  XVII  which  follows.) 
The  distribution  of  hospitals  seems  to  be  wide  enough  also  to  meet 
all  the  needs  of  the  day. 

5.  Richmond. 

In  the  Borough  of  Richmond  it  is  computed  that  for  present 
needs  135  hospital  beds  are  needed,  which  gives  an  excess  now  of 
96  beds.  (See  Table  XVII.)  With  the  comparatively  unsettled 
portions  of  large  parts  of  this  borough  and  the  low  rate  of  increase 
in  population  throughout,  there  does  not  seem  to  be  at  present  a 
need  for  any  additional  hospital  beds. 


54 

6.  Summary  of  Present  Needs. 

Summarizing  the  present  hospital  needs  of  the  city,  we  suggest 
that  immediate  steps  be  taken  to  erect  two  ambulance  stations  in 
Manhattan  of  8  beds  each,  one  on  the  lower  end  of  the  island,  and 
the  other  in  the  middle  West  Side ;  and  two  more  in  Brooklyn,  one 


Table  XVII. — Showing  Present  Bed  Capacity, 

Queens  and 


Name  of  Borough. 


[  St.  John's,  L.  I.  City } 

I  Flushing f 

Queens ?t.  Mary's  I  Jamaica \ 

Jamaica.  .  \  J  I 

[St.  Joseph's,  Far  Rock'y.  J 
Richmond j  S.  R.  Smith  Infirmary.  .  .  I 

I  St.  Vincent's f 


Names  of  General 

hospitals   in 

borough. 

Population 

of 

borough. 

Computed 
number 
daily 
sick 

Computed 
number 
needing 
hospital 

1905. 

m 
district. 

care  in 
1905. 

72,845 


1 ,609 


55 

in  North,  and  one  in  South  Brooklyn ;  and  also  a  general  hospital 
of  500  beds  in  North  Brooklyn.  The  proposed  Bradford  Street 
Hospital  should  also  be  built  at  once.  This  makes  in  all  632  addi- 
tional beds  for  Greater  New  York  required  to  meet  the  present 
acute  needs  in  Manhattan  and  Brooklyn. 


Proper  Bed  Capacity,  and  Beds  Needed  in  1920. 
Richmond. 


Present    Number    Gen- 
eral Hospital  Beds  in 
Borough. 

Excess 
or  lack 
.    of  beds 
in 
1905.* 

Population 

in 

1920. 

Number 

of  beds 

needed  in 

1920. 

Known 
number  of 

beds  in 

1920, 

including 

all  known 

additions. 

Excess  or 
lack  of 
beds  in 
1920.* 

By 

hospitals. 

Total. 

150] 
60 

72  \ 
70  | 
40  J 

392 

24 

406,676 

899 

520 

370 

161  1 
70  f 

«3 1 

96 

94,700 

210 

231 

21 

*Black  face  type  denotes  excess  in  bed  capacity;  ordinary  type  denotes  lack. 


5^ 


II.     FUTURE  NEEDS. 


In  determining  the  hospital  needs  of  Greater  New  York  in  1920, 
five  factors  of  particular  importance  must  be  mentioned. 


Willingness  to  Go  to  Hospitals. 

(1)  The  first  of  these  factors  which  will  act  as  a  determinant  of 
the  number  whG  will  need  hospital  treatment  in  1920  is  the  increased 
willingness  on  the  part  of  the  public  to  go  to  hospitals.  It  is  a  well 
noted  fact  that  hospitals  are  being  used  much  more  largely  by  the 
general  public  to-day  than  they  were  a  decade  or  a  decade  and  a 
half  ago.  Even  within  the  last  fifteen  years  the  reputation  of  the 
hospital  has  changed  in  the  public  mind  from  an  institution  of  ill 
repute,  where  paupers  were  the  principal  patients,  to  a  place  where 
to-day  the  rich  and  the  poor  alike  seek  relief  and  health.  From  an 
institution  with  a  stigma  attached  to  its  name  and  in  which  the 
public  had  little  or  no  confidence,  the  hospital  has  developed  into  an 
institution  of  very  high  repute,  and  one  in  which  universal  confi- 
dence is  placed.  This  increased  willingness  on  the  part  of  the 
people  to  use  hospitals  has  not  ceased,  and  is  to-day  increasing. 
Every  year  more  people  are  seeking  relief  in  hospitals.  There  is 
hardly  a  general  hospital  in  Greater  New  York  which  does  not 
report  an  increase  in  patients  in  1905  over  1904.  That  this  popular 
use  of  hospitals  will  continue  to  grow  is  beyond  question.  The 
rapid  development  of  Greater  New  York  into  a  city  of  apartment 
and  tenement  houses,  together  with  the  modern  "  bachelor  move- 
ment," if  it  may  be  so  called,  on  the  part  of  both  sexes,  is  preparing 
a  class  of  people  who  will  in  years  to  come  be  more  and  more 
dependent  on  the  hospital  as  a  place  of  last  resort  in  case  of  sick- 
ness. The  increasing  favor  of  the  hospitals,  due  also  to  their  great 
success  in  caring  for  the  sick,  will  likewise  tend  to  increase  the 
number  of  applicants  to  these  institutions. 

On  October  1.  1890,  there  were  in  the  general  hospitals  of  Greater 
New  York  4,045  patients.  In  1905  the  number  of  patients  had 
increased  85%,  or  to  7,504  patients.  The  general  population  of 
Greater  New  York  increased  during  the  same  period  64%.  It  will 
thus  be  seen  that  the  hospital  population,  in  the  general  hospitals 
alone  of  Greater  New  York,  increased  20%  more  rapidly  than  did 
the  general  population  during  the  same  period.  Another  figure 
will  show  more  clearly  the  use  of  hospitals  in  the  last  fifteen  years. 


->■. 


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SHOVi/WQ      PRESENT  HOSPITAL  SYSTEM 
AND    CHANCES    RECOMME/VDED    TO   m\0 


57 

In  1890,  7%  of  the  computed  number  of  sick  people  of  acute  and 
chronic  diseases,  excluding  contagious  and  tuberculosis,  were  in 
hospitals.  In  1905  8.4%  of  these  same  classes  of  sick  were  in  the 
general  hospitals.  It  will  thus  be  seen  that  there  are  now  1.4 
people  more  in  every  100  sick  in  the  general  hospitals  of  the  city 
than  were  in  them  in  1890.  This  increased  desire  on  the  part  of 
the  public,  rich  and  poor,  to  use  hospitals  must  be  a  vital  fact  in 
determining  the  future  needs  of  the  city. 

Needs  of  Business  Sections. 

(2)  A  second  determining  factor  in  gaining  an  idea  of  the 
hospital  needs  of  1920  will  be  the  needs  of  business  sections  at 
that  time.  While  the  factor  of  increase  of  population,  which  will 
be  treated  later,  is  vital,  there  are  some  sections  where  the  decrease 
of  population  brought  about  by  the  growth  of  business  activity  is 
just  as  vital.  Such  sections  as  these  are  the  lower  end  of  Manhattan 
below  Canal  street,  the  upper  Heights  and  Navy  Yard  district  of 
Brooklyn,  and  the  business  centers  of  every  borough.  The  question 
arises  at  once  how  much  will  such  sections  require  hospital  accom- 
modations in  years  to  come.  These  business  centers  of  any  borough 
in  the  very  nature  of  the  case  cannot  become  residence  sections. 
The  demands  of  business  and  trade  are  constantly  encroaching 
upon  the  fringe  of  the  residential  sections  which  border  these  dis- 
tricts. To-day-  one  needs  only  to  pass  down  in  any  of  the  cross 
streets  between  14th  and  23d  in  Manhattan,  for  instance,  and  note 
how  business  is  encroaching  upon  the  residential  section  between 
Sixth  and  Seventh  avenues.  Every  year  sees  old  houses  here 
turned  into  stores  or  factories,  or  torn  down  to  make  way  for  busi- 
ness blocks.  The  question  arises  then,  if  this  inroad  of  business  into 
the  residential  section  continues,  is  there  really  need  for  more  hos- 
pital accommodations  here?  Granting  that  the  sections  now  given 
over  to  business  will  become  more  and  more  so  in  years  hence,  it 
seems  that  there  will  still  be  need  for  hospitals  in  such  sections. 
Although  the  actually  resident  population  in  every  one  of  these  sec- 
tions is  decreasing,  the  daytime  population  composed  of  clerks, 
mechanics  and  business  men  is  increasing  and  will  continue  to  in- 
crease. The  necessary  congestion  of  such  districts  in  the  daytime 
results  in  a  large  number  of  accidents,  and  emergency  hospitals  are 
much  in  demand  in  these  districts. 

Increase  in  General  Population. 

•  (3)  A  third  factor  enters  in  as  determining  the  future  hospital 
needs  of  the  city,  and  this  is  the  increase  in  general  population  of 
the  city  to  1920.  This  question  was  discussed  in  Chapter  II,  sec- 
tion 6,  and  needs  no  further  mention  here.      (See  page  30.) 


58 

Increase  in  Hospital   Population. 

(4)  The  fourth  and  most  vital  factor,  however,  which  we  con- 
sider in  this  connection  is  the  increase  in  hospital  population  to 
1920.  This  increase  is  affected  in  turn  by  three  things,  viz. :  the 
rate  of  sickness  in  1920;  the  rate  of  attendance  at  hospitals;  and 
the  increase  of  population  in  1920. 

Rate  of  Sickness  in  1920. 

(a)  From  Table  XIV  it  was  demonstrated  that  there  are  in 
Greater  New  York  2,21  persons  sick  of  some  form  of  acute  or 
chronic  disease  in  every  hundred,  excluding  tuberculosis  and  con- 
tagious diseases.  (See  page  38.)  While  the  general  death  rate  has 
decreased  rapidly  in  the  past  fifteen  years,  from  24.58  per  1,000  of 
population  in  1890,  to  18.31  in  1905,  the  death  rate  in  acute  and 
chronic  diseases,  excluding  tuberculosis  and  contagious  diseases, 
decreased  but  one-half  as  fast,  viz.:  from  18.21  to  15.38  in  the  same 
period.  It  will  thus  be  seen  that  by  using  the  death  rate  as  an 
indication  we  may  conclude  that  the  actual  decrease  in  the  amount 
of  sickness  in  the  above  specified  classes  has  been  very  slight. 
That  the  death  rate  in  tuberculosis  and  other  contagious  and  infec- 
tious diseases  will  be  lowered  in  the  next  fifteen  years  is  beyond 
question.  But  that  it  will  be  appreciably  lowered  in  the  other  classes 
of  disease  is  open  to  considerable  discussion.  There  will  no  doubt 
continue  to  be  an  advance  in  medical  science,  but  this  advance  to-day 
is  having  the  effect  of  not  only  decreasing  the  death  rate  but 
lengthening  the  term  of  disease.  People  live  to-day  much  longer 
of  certain  diseases  than  they  did  fifteen  years  ago,  and  this  will  no 
doubt  be  true  in  1920.  The  high  tension,  however,  of  life  in  New 
York,  combined  with  overindulgence  in  food  and  luxuries,  is  now 
tending  to  increase  the  number  of  deaths,  and  likewise  the  amount 
of  sickness,  in  certain  diseases  of  the  circulatory  and  nervous 
systems.  The  latest  reports  of  the  Department  of  Health  show  a 
large  increase  in  heart  disease.  Newsholme  has  proven  that  the 
death-rate  in  cancer  and  Bright's  disease  also  has  steadily  increased, 
meaning  a  greater  amount  of  sickness  in  those  diseases.  (See  Vital 
Statistics,  page  276.)  In  view  of  these  facts,  therefore,  it  seems 
safe  to  conclude  that  the  present  rate  of  sickness  (2.21  per  100) 
will  be  maintained  to  1920,  and  that  in  calculating  the  hospital 
population  of  the  city  on  that  date  this  rate  should  be  used. 

Hospital  Rate  in  1920. 

(b)  As  to  the  rate  of  attendance  in  hospitals,  it  cannot  be 
doubted  that  the  percentage  of  sick  who  now  go  to  general  hos- 
pitals will  be  larger  than  it  is  now.  In  a  previous  connection  it 
was  shown  that  in  using  the  present  rate  of  hospital  attendance 
(8.4%)  as  an  indication  of  how  many  sick  were  now  needing  hos- 


59 

pital  treatment,  we  were  using  a  most  conservative  figure.  (See 
page  2,7-)  In  l89°'  the  total  number  of  sick  who  belonged  in 
general  hospitals  was  7%,  making  an  actual  increase  in  the 
fifteen  years  in  these  acute  and  chronic  diseases  only  of  1.4%  in 
the  rate  of  hospital  attendance.  In  view  of  this  fact,  together  with 
the  increasing  use  of  hospitals,  which  is  discussed  above,  it  seems 
a  most  conservative  estimate  to  say  that  at  least  10%  of  the  sick 
who  will  rightly  belong  in  general  hospitals  will  be  there  in  1920. 
The  head  workers  of  the  largest  district  nursing  association  in 
the  city  support  this  conclusion.  They  hold  that  the  rate  will  be 
at  least  10%  and,  with  little  doubt,  more.  From  three  years  of 
experience  among  the  lower  East  Side  population  the  rate  of  hos- 
pital attendance  seems  to  be  constantly  increasing.  In  1904,  of 
all  the  cases  under  care,  9%  were  sent  to  hospitals.  In  1905  this 
number  increased  to  10%.  In  1906  the  ratio  was  13.3%.  This 
experience,  together  with  the  several  facts  above  cited,  have  led 
to  using  a  rate  of  hospital  attendance  of  10%  in  computing  the 
number  of  sick  needing  general  hospital  care  in  1920. 

Increase  in  Population  in  1920. 

(c)  The  increase  in  hospital  population  in  1920  is  further  af- 
fected by  the  increase  of  the  general  population  in  the  various 
localities  used  as  units  of  distribution  in  Tables  XV  to  XVIII. 
In  order  to  arrive  at  the  proper  computed  bed  capacity  of  the 
different  districts  and  so,  for  the  city  as  a  whole,  the  increase  of 
population  in  each  district  was  computed  upon  the  basis  of  the 
increase  in  that  district  from  1900  to  1905,  together  with  a  com- 
parison of  the  increase  from  1880-1905.  This  method  seems  to 
give  much  better  results  than  that  of  using  the  same  rate  of  in- 
crease for  each  section,  since  in  some  districts  of  the  city,  population 
is  at  a  practical  standstill,  while  in  others  it  is  increasing  at  a  very 
rapid  rate. 

Method  of  Computation. 

(d)  With  the  rate  of  sickness  and  the  percentage  of  sick  who 
will  be  in  general  hospitals  in  1920  established,  the  number  of  sick 
needing  hospital  care  fifteen  years  hence  is  then  computed 
from  the  estimated  population.  In  each  district  the  population 
computed  in  1920  was  multiplied  by  .0221,  the  rate  of  sickness, 
thus  giving  the  number  of  sick  of  acute  and  chronic  diseases 
(excluding  tuberculosis  and  contagious  diseases)  in  1920.  Of  this 
product,  10%,  the  rate  of  hospital  attendance,  was  taken,  thus 
giving  the"*  number  of  sick  in  1920  who  should  be  in  the  general 
hospitals  of  the  city  on  that  date.     . 

Centralization  vs.  Distribution. 

(5)  Having  found  now  the  number  of  sick  who  should  properly 
be  treated  in  a  general  hospital  in  1920,  there  still  remains  another 


6o 

factor  which  should  be  considered  as  affecting  the  distribution  of 
this  number.  And  that  is  the  question  as  to  how  far,  in  a  well- 
regulated  hospital  system,  such  as  is  proposed  here,  should  the  bed 
capacity  be  distributed  and  how  far  should  it  be  centralized. 

There  are  few,  if  any,  hospital  authorities  who  do  not  agree  that 
a  certain  amount  of  centralization  is  absolutely  necessary.  It  is 
impossible  for  every  hospital  to  keep  everyone  who  seeks  admission 
to  the  institution  just  as  long  as  that  individual  wants  to  or  is 
obliged  to  stay.  If,  for  instance,  as  Superintendent  Fisher  of  the 
Presbyterian  Hospital  says,  they  should  keep  at  their  hospital  every 
case  of  fractured  legs  only,  that  were  brought  in  to  them,  in  a  month 
or  six  weeks  every  bed  in  the  hospital  could  be  filled  with  these 
cases.  And,  when  it  is  noted  that  an  ordinary  fractured  leg  keeps 
a  patient  in  bed  for  from  three  to  eight  weeks,  it  will  be  seen  how 
utterly  impossible  it  is  for  the  smaller  general  hospitals  to  keep  such 
cases  for  more  than  a  very  short  time.  Again,  if  every  small  gen- 
eral hospital  were  to  keep  all  the  chronic  cases  which  come  to  them 
for  treatment  as  long  as  they  need  care,  they  would  all  be  filled  with 
these  diseases  within  less  than  a  year.  Consequently,  it  is  necessary 
to  have  some  central  hospital  to  which  these  and  similar  cases  can, 
if  necessary,  be  transferred,  and  where  they  can  be  kept  until  either 
convalescence  or  complete  recovery. 

The  question  remains,  then,  as  to  how  large  this  centralization 
should  be.  During  the  year  1905  about  one-fourth  of  the  cases 
treated  at  Bellevue  Hospital  were  transferred  from  other  hospitals. 
In  addition  to  these  cases  treated  at  Bellevue,  over  17,000  cases 
were  treated  during  the  year  at  the  Metropolitan  and  City  Hos- 
pitals, which  have  no  ambulance  territory  of  their  own  and  receive 
their  cases  largely  as  transfers  from  Bellevue  and  other  hospitals. 
The  present  bed  capacity  of  the  island  institutions,  together  with 
one-fourth  of  the  present  capacity  of  Bellevue,  gives  about  1,500 
beds  now  used  for  chronic  and  other  cases  that  must  be  transferred 
to  a  central  hospital.  At  present  this  number  seems  to  be  insuffi- 
cient as  both  Bellevue  and  -the  City  and  Metropolitan  Hospitals 
are  much  overcrowded,  especially  during  the  winter  months.  (See 
reports  of  New  York  City  Visiting  Committee,  1904  and  1905.) 
When,  however,  the  additions  to  Bellevue  Hospital,  now  in  course 
of  construction,  are  completed,  and  400  additional  beds  at  the  City 
and  Metropolitan  Hospitals,  as  proposed  by  alterations,  are  gained, 
the  number  of  beds  for  central  hospital  purposes  will  be  ample. 
If  in  1920  there  is  a  lack  of  beds  for  chronic  cases,  it  is  suggested 
that  a  considerably  larger  percentage  of  the  capacity  of  Bellevue 
than  now  is  used,  together  with  the  enlarged  capacity  of  the  island 
institutions,  be  utilized  for  this  purpose.  The  argument  here  is 
obvious,  for  if  we  are  to  have  central  municipal  hospitals  of  large 
capacity,  which  by  their  very  location  cannot  supply  the  local  needs 
of   small   outlying  districts,   then   it   is   plain   that   this    centralized 


6i 

capacity  should  be  utilized  as  far  as  practicable  for  such  cases  as 
cannot  be  treated  in  the  smaller  hospitals,  but  which  can  be  trans- 
ferred to  the  large  ones. 

If  the  hospitals  in  New  York,  moreover,  are  to  be  run  first  and 
foremost  for  the  care  of  the  sick  (the  education  of  doctors  and 
nurses  being  secondary),  it  follows  that  in  view  of  the  growing 
need  and  demand  for  them,  these  institutions  should  be  built  where 
they  are  most  easily  accessible  to  the  people.  No  person  in  1920 
ought  to  be  compelled  to  travel  more  than  two  miles  within  the 
limits  of  Greater  New  York  in  order  to  receive  hospital  treatment 
for  an  acute  disease.  This  is  not  only  humane  but  it  is  also  a  matter 
of  health  economy.  The  municipal  hospital  should  be  the  means 
in  its  own  sphere  of  both  economizing  the  health  of  the  people  of 
its  own  district  and  of  educating  them  in  better  methods  of  sanita- 
tion and  hygiene. 

These  five  factors,  the  increasing  use  of  hospitals ;  the  needs  of 
business  sections ;  the  increase  of  general  population ;  the  increase 
of  hospital  population ;  and  the  amount  of  centralization  of  bed 
capacity  required, — all  these  will  have  great  weight  in  determining 
the  hospital  needs  of  Greater  New  York  in  1920.  In  giving  the 
following  conclusions  as  to  the  number  and  distribution  of  hospitals 
fifteen  years  from  now,  all  of  these  factors  are  considered,  and  thus 
the  most  accurate  results  obtainable  are  given. 

As  in  stating  the  present  needs,  so  also  in  the  future  needs  the 
city  is  divided  into  boroughs  and  the  various  districts  within  each 
borough  are  taken  up  separately.  The  method  of  finding  the  hos- 
pital needs  of  each  district  is  as  follows :  After  the  population  of 
the  district  in  1920  had  been  estimated,  2.21%  (the  rate  of  sickness) 
was  taken  of  this  figure.  Then  10%  (the  hospital  rate)  was  taken 
of  this  product.  This  gave  the  number  of  sick  who  should  properly 
be  treated  in  general  hospitals  in  1920.  This  difference  was  further 
modified  by  the  various  factors  above  enumerated.  From  this 
number,  however,  was  deducted  the  number  of  beds  in  each  dis- 
trict which  it  was  definitely  known  were  to  be  added  before  1920. 
This  difference  gives  the  number  of  hospital  beds  needed  in  the 
district  in  1920.  These  additions  are  taken  from  the  statements 
of  the  various  hospital  superintendents  and  managers.  A  number 
of  hospitals  have  indefinite  plans  for  additions,  but  these  have  not 
been  credited  as  "  known  additions  "  in  1920  in  Tables  XV-XVIII. 

1.  Manhattan. 

Considering  the  Borough  of  Manhattan  as  a  whole,  it  is  noted 
that  only  two  of  the  ten  ambulance  districts  show  an  excess  of  beds 
over  the  required  capacity,  minus  the  known  additions  to  1920. 
(See  Table  XV.)  The  lack  of  beds  for  the  whole  borough  (81) 
is  not  a  fair  indication  of  the  hospital  needs,  since  the  same  situation 
will  prevail  in   1920  as  to-day.     Fifteen  years  from  now  a  larger 


62 

number  of  the  beds  of  the  borough  will  be  centralized  in  the  middle 
and  upper  East  Side  than  at  present,  while  many  of  the  other 
districts  will  show  a  large  lack  of  beds. 

Middle  and  Upper  East  Side. — In  the  Bellevue  ambulance  district 
for  1920  an  excess  of  over  1,600  beds  is  computed.  (See  Table  XV, 
p.  41.)  While  none  of  the  other  hospitals  have  any  known  addi- 
tions planned  for,  Bellevue  has  definite  plans  for  doubling  its  present 
capacity  to  2,000  beds.  In  fact  work  is  rapidly  progressing  on  two 
of  the  pavilions,  which  will  be  completed,  in  1908.  It  is  incon- 
ceivable that  Bellevue  should  ever  use  this  enlarged  capacity,  or 
even  a  considerable  percentage  of  it,  to  meet  the  needs  of  its  im- 
mediate district,  which  will  in  1920  require  less  than  one-half 
the  number  planned  for  by  Bellevue  alone.  On  this  ac- 
count, Bellevue  will  be  obliged,  and  should  properly  be  com- 
pelled, to  become  more  and  more  a  central  hospital  for  the  Borough 
of  Manhattan.  Here  should  be  sent  the  large  number  of  cases 
which  cannot  be  treated  by  the  smaller  hospitals  and  ambulance 
stations.  Here  should  come  a  large  number  of  chronic  cases  for 
whom  we  have  hardly  any  provision  to-day.  In  fact,  the  large 
proportion  of  the  other  hospitals  of  this  district  will  in  1920,  as 
they  do  now,  serve  the  city  at  large  and  not  the  needs  of  this  par- 
ticular district.  Thus  the  seemingly  large  excess  of  the  Bellevue 
district  will  be  none  too  large  when  considered  in  this  light. 

The  Presbyterian  district  shows-  a  slight  excess  in  1920,  while 
the  Flower  district  just  below  it  shows  a  lack  of  over  200  beds. 
While  at  first  thought  this  situation  might  seem  to  indicate  a  need 
for  another  hospital  here,  when  considered  in  the  light  of  all  the 
facts,  this  need  is  not  apparent.  The  East  Side,  it  is 
admitted,  between  40th  and  96th  streets  is  growing  very  rapidly, 
and  will  doubtless  continue  to  grow  till  1920  at  its  present  rate  at 
least.  Nevertheless  the  large  excess  of  beds  just  to  the  south  of 
this  district  and  the  smaller  excess  just  to  the  north  will  doubtless 
more  than  neutralize  this  increase  in  population.  The  distances, 
moreover,  are  not  so  great  but  that  anyone  in  the  Flower  ambulance 
district  can  even  now  get  to  the  Presbyterian,  Flower,  or  Bellevue 
Hospitals  with  less  than  a  two-mile  walk.  On  this  account  it  is 
thought  that  the  hospital  facilities  between  Houston  and  96th 
streets  will  be  ample  in   1920. 

Lower  East  Side. — If  the  number  of  beds  above  Flouston  street 
on  the  East  Side  will  be  sufficient  in  1920,  it  is  assured  from  every 
known  factor  entering  into  the  question  that  the  number  of  beds 
needed  below  Houston  street  will  be  entirely  inadequate,  even  with 
the  addition  of  the  ambulance  station  mentioned  above  (see  page 
46),  for  the  immediate  needs  of  the  district. 

Considering  the  district  mentioned,  below  Houston  street  on  the 
East  Side,  including  also  the  Lower  Manhattan  section  below 
Canal  street,  the  computed  number  of  beds  needed  here  in  1920  is 


63 

over  400.  That  this  number  is  none  too  large  is  evidenced  by  the 
added  weight  brought  to  bear  upon  it  by  the  other  factors  entering 
into  the  case.  Before  stating  these  other  factors  it  should  be  noted 
that  in  this  number  are  included  the  beds  needed  for  present 
use,  and  mentioned  above,  which  are  not  included  in  "  known 
additions  "  in  Table  XV. 

The  increased  use  of  hospitals,  which  is  to  be  a  great  determining 
factor  in  the  hospital  needs  of  1920,  is,  perhaps,  more  evidenced  in 
the  Lower  East  Side  district  below  Houston  street  than  in  any  other 
section  of  the  city.  The  population  here  are  daily  realizing  the  value 
of  the  hospitals  and  are  becoming  more  and  more  inclined  to  use 
them  in  cases  of  necessity.  The  recent  improvement  of  Gouverneur 
Hospital  in  this  district  has  added  much  to  the  appreciation  and 
value  of  this  hospital  in  the  community.  When  the  present  cam- 
paign of  education  among  the  people  of  this  district,  now  in 
progress,  has  realized  its  effects,  and  when  wholesome  and  well- 
equipped  municipal  hospitals  have  been  provided  for  the  sick, 
the  use  of  these  institutions  will  without  doubt  be  very  largely 
increased.  This  rising  demand  for  hospitals  here  as  elsewhere 
will  mean  an  increased  saving  of  life,  shortened  terms  of  sick- 
ness, and  hence  an  increase  in  the  economic  efficiency  of  the 
community. 

In  addition  to  the  increasing  demand  for  hospitals  in  the  Lower 
East  Side  district,  must  be  noted  the  rising  demands  of  the  busi- 
ness sections  here  and  in  the  extreme  lower  end  of  the  island.  The 
rapid  remodelling  and  enlarging  of  many  of  the  large  business 
blocks  in  this  district,  the  erection  of  enormous  new  structures,  the 
continued  influx  of  manufacture  and  trade  of  all  sorts  into  the 
territory  below  Canal  and  Houston  streets  is  a  sufficient  indication 
of  the  large  increase  in  daytime  population  here  by  1920.  At  pres- 
ent a  most  conservative  estimate  places  this  daytime  population  at 
500,000.  By  1920,  there  is  little  doubt  but  that  it  will  be  ciose  to 
a  million.  This  increase  means  more  congestion  of  traffic  in  the 
streets,  more  machinery  and  men  in  the  buildings,  and  consequently 
many  more  accidents.  This  means,  in  other  words,  more  hospitals 
needed. 

The  computed  proper  bed  capacity  on  the  Lower  East  Side  has 
been  figured  at  a  most  conservative  rate  of  increase  in  population, 
but  even  at  a  7%  increase,  and  allowing  for  no  compounding  of 
this  increase,  trie  population  will  in  fifteen  years  be  nearly  325,000. 
This  increase  means  more  hospital  needs. 

The  hospital  needs  of  this  district  below  Houston  street  will  be 
affected,  no' doubt,  by  increased  central  hospital  facilities.  A  con- 
siderable percentage  of  the  natural  increase  in  general  hospital 
population  in  1920  will  doubtless  be  of  such  a  nature  that  it  can 
be  cared  for  in  a  central  hospital.  When,  moreover,  the  complete 
rebuilding  of  Bellevue  Hospital,  and  the  rejuvenation  of  the  Black- 


64 

well's  Island  Hospitals,  by  the  removal  of  the  penal  institutions,  shall 
have  taken  place,  the  present  dislike  of  these  hospitals  among  the 
poor  of  this  district  will  give  way  to  an  increased  confidence.  Thus 
the  local  needs  of  the  downtown  districts  may  be  somewhat  relieved 
by  this  increasing  willingness  to  submit  to  being  transferred  to  one 
of  the  central  institutions. 

From  a  consideration  of  all  of  these  factors  entering  into  the 
case,  it  is  suggested  that  a  local  hospital  of  at  least  ioo  beds  will  be 
needed  in  1920  for  the  Gouverneur  and  House  of  Relief  ambulance 
districts.  As  to  the  location  of  these  beds,  it  is  suggested 
that  they  should  be  built  in  a  hospital  near  the  Bowery 
and  Spring  street.  A  hospital  here  would  have  the  double  advan- 
tage of  supplying  the  needs  not  only  of  the  district  to  the  east,  but 
would  be  also  easily  accessible  to  the  district  to  the  west.  This 
western  territory,  even  with  its  almost  stationary  population,  will 
need  more  hospital  accommodations,  and  a  hospital  centrally  located 
could  fill  all  the  needs. 

Middle  West  Side. — Another  section  of  the  city  which  will  doubt- 
less require  additional  hospital  accommodations  in  1920  is  the 
Middle  West  Side.  The  various  factors  which  influence  the  present 
needs  of  this  district  apply  with  added  force  to  the  future  needs. 
In  addition  to  these  factors  are  the  five  determining  facts  stated  in 
the  introduction  to  this  section  of  future  needs,  all  of  which  will 
influence  the  hospital  needs  of  1920.  In  addition  to  the  8  beds 
demanded  for  immediate  needs  in  this  district,  there  is  little  doubt 
but  that  an  additional  100  beds  at  least  will  be  needed  in  this  pro- 
posed ambulance  station  in  1920.  That  this  is  a  conservative  figure, 
is  evidenced  by  the  fact  that  it  is  computed  that  about  400  beds  will 
be  needed  between  14th  and  86th  streets  by  1920.  (See  Table  XV, 
p.  41.) 

Upper  Harlem. — In  the  upper  Harlem,  including  all  the  territory 
above  96th  street,  it  is  computed  that  700  beds  will  be  needed  in 
1920  in  addition  to  those  now  provided  for.  Although  this  number 
includes  all  needed  beds  less  known  additions  to  1920,  there  are 
some  indefinitely  planned  additions  in  this  district  which  will  prob- 
ably reduce  this  number  at  least  100  more.  Another  factor  enters 
in  to  modify  the  computed  number  of  beds  in  this  district,  and  that 
is,  that  the  increase  in  hospital  attendance,  which 'was  for  the  entire 
city  computed  at  a  rate  of  10%  in  1920,  will  doubtless  be  smaller  in 
this  district  than  for  the  city  as  a  whole.  The  large  class  of  wealthy 
residents  in  this  district,  together  with  a  considerable  number  of 
individual  homes,  render  it  liable  that  the  rate  of  attendance  in  the 
Lower  Harlem,  at  least,  will  doubtless  be  lower  than  for  the 
downtown  districts. 

These  factors  lead  to  the  conclusion  that  at  least  200  additional 
beds  will  be  needed  above  96th  street  in  1920.  As  to  the  distribu- 
tion of  these,  it  is  deemed  probable  that  200  beds  will  need  to  be 
added  by  1920  to  the  New  Harlem  Hospital.     An  ambulance  station 


65 

of  8  beds  to  meet  the  needs  of  the  West  Side  of  Harlem  will  be 
needed  in  1920.  This  station  should  be  built  preferably  in  the 
vicinity  of  Audubon  Park,  where  it  will  be  central  to  all  the  Upper 
West  Side.  Another  ambulance  station  in  the  southeast  part  of  this 
district,  preferably  on  the  site  of  the  old  Harlem  Hospital  at  120th 
street  and  East  River  will  also  be  needed  before  1920.  With  a 
well-equipped  municipal  hospital  in  this  Upper  Harlem  district,  and 
a  good  system  of  ambulance  stations,  the  scandal  of  transferring 
acutely  sick  patients  from  Dyckman  street  or  Spuyten  Duyvil  to 
Bellevue  or  Blackwell's  Island  will  be  averted. 

2.  The  Bronx. 

The  hospital  needs  of  the  lower  Bronx  are  adequate  for  both 
present  needs  and  those  in  1920.  The  same  cannot  be  said,  how- 
ever, of  the  upper  Bronx,  including  the  Fordham  and  Williams- 
bridge  sections.  The  supervising  nurse  of  the  Fordham  Hospital, 
who  has  had  ten  years'  experience  in  that  district,  gave  as  her 
opinion  that  the  new  hospital  with  100  additional  beds,  to  be  opened 
soon,  will  be  full  and  overcrowded  in  five  years.  The  present 
rapid  growth  of  this  section,  with  the  totally  inadequate  hospital 
provisions,  seem  to  warrant  the  possibility  of  this  statement.  At 
present  there  is  no  general  hospital  north  of  150th  street  in  the 
Bronx  besides  the  New  Fordham  Hospital.  In  view  of  these  facts 
it  is  computed  that  an  addition  of  at  least  100  beds  will  be  needed  in 
the  New  Fordham  Hospital  by  1920.  To  meet  the  needs  of  Kings- 
bridge  as  well  as  the  northern  section  of  Harlem  adjoining,  it  is 
suggested  that  an  ambulance  station  be  built  in  the  former  district 
before  1920. 

3.  Brooklyn. 

In  Brooklyn,  as  in  Manhattan,  the  total  computed  lack  of  beds 
(1,251)  for  the  needs  of  1920  is  not  a  fair  indication  of  the  exact 
number  needed,  since  three  of  the  seven  districts  show  an  excess 
of  beds.  It  is  necessarv,  therefore,  to  consider  the  needs  bv  sections. 
(See  Table  XVI,  p.  51.) 

North  Brooklyn. — As  shown  in  Table  XVI,  the  greatest  need 
for  hospitals  in  Brooklyn  in  1920  will  be  in  the  northern  section 
of  the  city.  In  the  territory  comprising  Bedford,  Williamsburgh 
and  Bushwick,  or  practically  all  the  territory  north  of  Lafayette 
avenue  and  Broadway,  it  is  computed  that  there  will  be  needed  in 
1920  over  1,000  additional  hospital  beds.  At  first  thought  this  may 
seem  an  abnormally  large  number,  but  when  it  is  considered  that 
here  is  a  section  which  to-day  has  less  than  500  hospital  beds  and 
where  only  100  additional  beds  are  being  contemplated  for  the  next 
fifteen  years,  the  above  figure  does  not  seem  much  too  large. 
Again,  while  population  in  this  territory  will  increase,  beyond  a 
doubt,  at  least  40%  in  the  next  fifteen  years,  and  hospital  needs  at 
a  still  higher  rate,  if  left  without  any  municipal  action,  the  bed 


66 

capacity,  from  all  known  indications,  will  increase  but  about  20%. 
This  argument  is  strengthened  when  it  is  recalled  that  the  present 
needs  of  the  district  are  inadequate  and  that  it  was  recommended 
that  500  beds  be  added  at  once  in  this  territory.      (See  page  52.) 

The  attempt  to  distribute  over  1,000  beds  within  so  limited  an 
area  must  necessarily  be  attended  with  some  degree  of  uncertainty, 
owing  to  the  constant  shifting  of  population  within  the  district. 
However,  there  is  no  doubt  that  a  hospital  of  100  beds  will  be 
needed  in  the  northern  part  of  ward  19  or  southern  part  of  ward  15 
to  replace  the  ambulance  station  proposed  for  present  needs.  The 
Greenpoint  and  Williamsburg  sections,  with  their  present  scanty 
hospital  protection,  will  in  1920  demand  an  ambulance  station,  at 
least.  The  present  development  of  the  district  bordering  on  the 
Cumberland  Street  Hospital  will  call  in  1920  for  a  doubling  of  the 
capacity  of  that  institution  or  the  rebuilding  it  for  100  additional 
beds.  This  will  be  so,  especially  if  the  district  to  the  eastward 
continues  to  lose  its  residential  population,  as  it  is  fast  doing,  and 
becomes  more  and  more  a  business  center.  The  rapid  growth  of 
this  North  Brooklyn  district,  coupled  with  the  growth  of  the  adja- 
cent section  in  Queens,  will  demand  the  enlargement  of  the  above 
proposed  general  hospital  in  the  28th  ward  to  700  beds.  Thus,  in 
this  northern  section  of  Brooklyn,  400  beds  at  least  will  be  needed 
in  1920,  in  addition  to  the  present  needs. 

South  Brooklyn. — Another  section  of  Brooklyn  which  will  demand 
more  hospitals  in  1920  is  South  Brooklyn,  or  wards  30,  31,  and  32. 
The  rapid  growth  of  population  in  this  extremely  large  area  and  the 
paucity  of  hospital  accommodations  has  been  discussed  in  a  previous 
connection.  Every  indication  points  to  as  densely  settled  a  popula- 
tion in  South  Brooklyn  in  1920  as  is  at  present  in  Flatbush  and  the 
neighboring  sections,  although  to-day  there  are  less  than  ten  people 
to  the  acre  living  here.  But  with  a  prospective  growth  in  fifteen 
years  of  200%  at  least,  this  district  should  be  well  settled  in  1920. 
This  growing  population  will  need  hospital  accommodations. 

In  addition  to  the  ambulance  station  proposed  for  immediate  use 
in  the  Borough  Park  section  (see  page  53),  100  beds  more 
will  be  needed  in  this  hospital  by  1920.  To  the  south  and  west 
of  this  section  is  a  district  which  has  increased  at  the  rate  of 
50%  in  the  last  five  years.  This  district  will  undoubtedly  need 
attention  by  1920.  It  is  accordingly  suggested  that  an  ambulance 
station  be  located  in  the  Bath  Beach  district  between  the  new  Coney 
Island,  the  Norwegian  and  the  proposed  Borough  Park  Hospital. 
Such  a  hospital  should  have  a  capacity  of  at  least  8  beds.  To 
the  northeast  of  the  new  Coney  Island  Hospital  and  to  the  east  and 
southeast  of  the  Kings  County  Hospital  lies  the  district  of  Flat- 
lands,  which  has  increased  in  population  at  the  rate  of  45%  in  the 
last  five  years.  There  will  be  need  for  ambulance"  station  in  this 
section,  preferably  in  the  Waverly  district  in  the  northern  part  ot 


67 

the  32d  ward.  Such  an  institution  would  serve  not  only  as  a 
relief  to  the  overcrowded  Kings  County  Hospital,  but  would  supply 
a  need  for  the  growing  population  of  Flatlands,  Brownsville  and 
the  territory  to  the  east.  In  addition  to  these,  it  is  suggested  that 
by  1920  the  Coney  Island  Hospital,  which  is  about  to  be  started, 
be  enlarged  to  at  least  300  beds,  an  addition  of  200  to  the  present 
proposed  capacity.  To  meet  the  growing  needs  of  this  district  as 
well  as  those  of  the  city  as  a  whole,  the  Kings  County  Hospital 
should  be  enlarged  by  400  beds  before  1920. 

Thus,  to  meet  the  future  needs  of  this  South  Brooklyn  district, 
at  least  700  additional  beds  will  be  needed,  besides  those  demanded 
for  immediate  use. 

Summary  of  Brooklyn  Needs  in  1920. — Summing  up  the  future 
needs  of  Brooklyn,  we  find  that  in  North  Brooklyn  400  additional 
beds  will  be  needed ;  and  in  South  Brooklyn  700,  making  in  all 
1,100  beds  required  for  the  needs  of  Brooklyn  in  1920  over  and 
above  what  are  demanded  by  present  needs. 

4.  Queens. 

According  to  Table  XVII  (see  page  54),  which  is  computed  on  a 
rate  of  90%  increase  in  population  for  fifteen  years,  in  Queens  by 
1920  the  should  be  370  hospital  beds  lacking.  A  study  of  the  present 
hospital  population  of  this  district,  together  with  the  growing  needs 
of  the  borough,  convince  one  that  this  number  will  be  none  too 
many  beds  to  be  added  in  fifteen  years.  There  is  now  one  hospital 
in  the  first  ward,  or  Long  Island  City ;  none  in  the  2d  ward,  or  New- 
town ;  one  in  the  3d  ward,  or  Flushing ;  two  in  the  4th  ward, 
Jamaica;  and  one  in  the  5th  ward  at  Far  Rockaway.  At  present 
these  hospitals  seem  to  supply  all  the  needs  of  the  borough.  When, 
however,  within  less  than  five  years  Queens  Borough  has  been 
opened  up  to  residents  of  Manhattan  through  the  improved  transit 
facilities,  such  as  the  new  tunnels,  subways,  etc.,  there  is  little  doubt 
but  the  present  hospital  provisions  will  be  woefully  inadequate. 

In  view  of  these  facts  it  is  suggested  that  another  hospital  be 
located  in  Queens  by  1920.  This  should  be  of  100  beds  and  should 
be  located  in  Newtown,  which  adjoins  Bushwick  and  East  New 
York,  two  very  rapidly  developing  sections  of  Brooklyn,  and  which 
has  some  of  the  most  desirable  property  in  Queens.  An  ambulance 
station  should  be  located  in  the  western  end  of  Jamaica  in  the 
vicinity  of  Woodhaven.  An  institution  here  would  meet  the  de- 
mands of  a  population  which  is  bound  to  spread  southward  and 
which  to-day  adjoins  the  most  rapidly  developing  section  of  Brook- 
lyn. The  growing  needs  of  the  southern  section  of  this  borough 
demand  hospital  accommodations.  It  is  accordingly  suggested  that 
a  large  ambulance  station  of  about  25  beds  be  built  at  Rockaway 
Beach  by  1920.  The  continued  use  of  this  place  as  a  summer  resort 
makes  this  desirable.     Recently  the  board  of  trade  of  that  village 


68 

suggested  the  building  of  an  emergency  hospital  there,  and  it  is 
an  open  question  whether  a  small  station,  open  like  the  Coney 
Island  Hospital  only  in  the  summer,  would  not  do  good  service 
here.  At  present  the  St.  Joseph's  Hospital  at  Far  Rockaway,  three 
miles  away,  is  the  nearest  institution  having  an  ambulance. 

5.  Richmond. 

The  slow  increase  of  population  in  the  Borough  of  Richmond,  and 
its  now  ample  provision  for  all  hospital  needs,  do  not  indicate  an 
added  need  in  1920.  (See  Table  XVII,  p.  54.)  Unless  some  unfore- 
seen development  of  Staten  Island  takes  place  within  the  next  fifteen 
years,  the  present  hospital  provisions  will  be  large  enough  to  meet 
the  needs  of  1920.  That  Richmond,  however,  is  bound  to  develop 
when  rapid  transit  facilities  have  connected  it  with  the  rest  of  the 
city,  is  not  an  assumption.  This  development,  when  it  comes,  with 
its  influx  of  population  will  demand  more  hospitals ;  and  some  fore- 
sight should  now  be  used  in  securing  good  hospital  sites.  At  pres- 
ent there  is  no  hospital  on  the  southern  end  of  the  island.  It  is 
accordingly  suggested  that  an  ambulance  station  be  opened  here 
some  time  in  the  near  future.  This  would  do  away  to  a  large 
degree  with  the  barbarous  practice,  at  present  in  vogue,  of  trans- 
ferring acute  cases  and  even  emergency  cases  several  miles  from 
the  southern  to  the  northern  end  of  the  borough. 

6.  Blackwell's    Island,    Chronic    and    Convalescent    Institu- 

tions. 

In  the  above  treatment  of  the  future  hospital  needs  of  the  city, 
the  two  large  general  hospitals  on  Blackwell's  Island,  as  well  as 
several  other  hospitals  of  a  more  or  less  general  character,  have 
been  purposely  omitted.  (In  the  latter  class  of  hospitals  here  men- 
tioned would  come  the  hospitals  in  the  Homes  for  the  Aged,  and 
parts  of  the  Xew  York  City  Children's  Hospitals.) 

Beds  for  Chronic  Cases. 

The  reason  for  omitting  these  in  discussing  the  distribution  of 
general  hospitals  in  1920  is  obvious,  since  all  of  the  institutions  here 
mentioned  serve  the  needs  of  the  city  as  a  whole  for  special  pur- 
poses and  not  those  of  any  particular  district.  These  special  pur- 
poses are  the  care  of  chronic  diseases  or  of  acute  diseases  with 
prolonged  svmptoms.  A  previous  discussion  of  centralization  of 
bed  capacity  as  against  distribution  was  given  on  page  59.  It 
should  be  stated  here  that  every  factor  of  importance  leads  to  the 
conclusion  that  the  Blackwell's  Island  hospitals  should  eventually 
serve  for  the  reception  and  detention  of  chronic  diseases  of  a  pro- 
longed character  for  all  the  boroughs  of  the  city.  At  present  the 
chronic  cases  of  the  city,  such  few  as  are  cared- for  in  hospitals, 
are  distributed  in  part  in  the  hospitals  on  Blackwell's   Island,  at 


69 

the  hospital  wards  of  the  two  Homes  for  the  Aged  and  Infirm, 
at  Randall's  Island,  and  at  a  few  nobly  conducted  private  institu- 
tions, with  a  small  number  at  Bellevue  and  Kings  County  Hospitals. 
(This  discussion  of  chronic  relief  does  not  include  hospitals  for 
tubercular  patients.)  The  limited  accommodations  for  the  chronic 
sick  is  evidenced  by  the  constant  overcrowding  in  all  of  the  private 
hospitals  and  in  all  wards  of  the  public  institutions  who  treat  this 
class  of  patients. 

At  present  plans  are  being  prepared  to  give  additional  hospital 
space  at  the  City  Hospital  for  about  300  more  beds.  Some  added 
capacity  will  soon  be  given  to  the  Metropolitan  Hospital  also.  The 
Greater  Bellevue,  as  above  stated,  will  have  1,000  more  beds,  some 
of  which  can  be  used  for  chronic  cases.  If  all  cases  which  were 
not  of  a  strictly  chronic  nature,  requiring  hospital  care, 
were  excluded  from  the  Blackwell's  Island  institutions, 
probably  about  400  more  beds  could  be  made  available 
here  for  this  class  of  patients.  Thus,  without  any  more 
construction,  other  than  what  is  now  planned  for  in  Bellevue  Hos- 
pital, at  least  1,200  beds  for  chronic  cases  could  be  added  by  1920. 
In  addition  to  this  the  suggested  erection  of  a  general  hospital  in 
North  Brooklyn  (see  page  66),  will  by  1920,  provide  for  1,000 
beds,  and  the  proposed  enlargement  of  the  Kings  County  Hos- 
pital will  add  400  more.  It  is  accordingly  recommended  that  every  ■ 
effort  be  taken  to  centralize  all  the  chronic  hospital  population  in 
these  large  general  hospitals,  leaving  the  Randall's  Island  Hospitals 
to  care  for  the  same  class  which  they  now  do.  The  two  hospitals 
on  Blackwell's  Island  could  accommodate,  with  the  increases  in  the 
other  boroughs  suggested  above,  all  chronic  cases  in  the  city. 
With  the  improved  boat  service  to  Brooklyn,  which  the  Department 
of  Charities  is  perfecting,  it  will  be  an  easy  matter  to  transfer  from 
that  borough.  The  new  Blackwell's  Island  bridge  will  facilitate 
traffic  from  Queens  and  the  Bronx.  Thus,  Blackwell's  Island, 
when  cleared  of  the  penal  institutions  which  now  bring  it  in  bad 
repute,  and  made  easy  of  access  to  the  entire  city,  will  be  the  finest 
location  available  for  the  transfer  and  treatment  of  large  numbers 
of  chronic  cases.  This  centralization  of  the  chronic  cases  would 
mean  a  large  amount  of  relief  to  some  of  the  municipal  and  other 
hospitals. 

Beds  for  Convalescent  Cases. 

One  further  need,  with  which  this  report  has  not  yet  dealt,  should 
be  here  stated,  and  that  is  the  care  of  convalescent  patients.  Any 
comprehensive  plan  of  hospital  treatment  which  looks  forward  to  the 
most  economic  administration,  both  from  a  financial  and  a  hvgienic 
point  of  view,  should  include  some  adequate  place  where  convales- 
cent patients  may  be  sent.  There  are,  according  to  the  testimony 
of  our  best  hospital  superintendents,  thousands  of  patients  who  are 


;o 

now  being  turned  away  from  the  hospitals  as  "  cured  "  or  "  im- 
proved," but  who  really  need  to  go  somewhere,  where,  with  rest, 
fresh  air,  and  congenial  surroundings  they  can  recover  some  of 
the  strength  lost  during  sickness,  and  gain  not  only  a  "  cure  "  but 
health  restored  and  efficiency  to  work  again.  Such  a  place  must 
necessarily  be  out  of  the  way  of  traffic,  i.  e.,  isolated,  and  at  the 
same  time  easy  of  access.  This  latter  should  be  so,  because  few 
sick  people  would  go  to  a  convalescent  hospital  if  their  friends  and 
relatives  should  be  unable  to  visit  them,  because  of  the  loss 
of  time  and  expense  involved. 

Greater  New  York  has  just  such  a  place,  situated  in  one  of  the 
most  ideal  locations  imaginable.  That  is  Blackwell's  or  Randall's 
Island.  These  islands  are  both  isolated  and  central;  they  can  be 
made  most  congenial  in  surroundings,  and  also  easily  accessible 
from  all  five  of  the  city's  boroughs.  When. the  penal  institutions 
shall  have  been  removed  from  Blackwell's  Island,  and  the  entire 
center  part  of  the  island  cleared,  a  convalescent  hospital  could  be 
built  here,  and  the  proposed  park  in  this  part  of  the  island  utilized 
for  the  pleasure  and  comfort  of  this  class  of  patients.  Or,  when 
the  House  of  Refuge  has  been  removed  from  Randall's  Island, 
these  buildings  and  grounds  could  be  used  for  similar  purposes. 
The  conservative  estimates  made  in  the  above  distribution  of  hos- 
pital beds  in  1920  lead  to  the  conclusion  that  500  beds  for  con- 
valescents will  be  of  the  greatest  value  here  in  1920. 

In  a  word,  summing  up  the  situation  at  this  point,  Blackwell's 
Tsland,  should  be  given  over  entirely  to  the  care  of  the  sick,  both 
chronic  and  convalescent;  and  the  two  hospitals  here  should  be  en- 
larged by  1920  so  that  they  will  each  have  a  bed  capacity  of  at 
least  1,500  beds.  Here  should  be  the  center  of  a  system  of  hospitals 
which  should  have  its  ramifications  in  all  the  boroughs  of  the  city. 

7.  Summary  of  Future  Needs. 

Summing  up  the  future  needs  of  Greater  New  York  to  1920,  we 
note  that  in  Manhattan  100  beds  will  be  required  near  the  Bowery 
and  Spring  street  to  meet  the,  needs  of  the  Lower  East  Side  and 
Southern  Manhattan  districts.  The  ambulance  station  on  the  Middle 
West  Side,  above  suggested,  will  need  to  be  enlarged  to  100  beds. 
The  bed  capacity  of  the  New  Harlem  Hospital  will  need  to  be  in- 
creased by  200  beds.  Two  ambulance  stations,  one  on  the  Upper 
West  Side  of  Harlem  and  the  other  on  the  site  of  the  old  Harlem 
Hospital  will  also  be  needed. 

In  Brooklyn  the  proposed  general  hospital  in  the  28th  ward  will 
need  to  be  enlarged  to  700  beds.  The  two  ambulance  stations 
suggested  for  present  needs,  one  at  Flushing  avenue  and  Broadway, 
and  the  other  in  South  Brooklyn  should  be  enlarged  to  100  beds 
each.  The  bed  capacity  of  the  Coney  Island  Hospital  should  be 
increased  bv  200  beds,  and  that  of  the  Kings  County  Hospital  to  400 


7i 

beds.  Three  ambulance  stations  will  also  be  needed  to  complete  the 
hospital  system  of  Brooklyn  in  1920,  one  in  Williamsburgh,  one  in 
the  northern  part  of  Canarsie,  and  one  in  Bath  Beach. 

In  the  other  boroughs  of  the  city,  an  addition  of  100  beds  will 
be  needed  to  the  New  Fordham  Hospital  in  The  Bronx,  and  an 
ambulance  station  on  the  west  side  of  this  borough.  In  Queens 
100  beds  in  a  new  hospital  in  Newtown,  and  two  ambulance  stations, 
one  in  Jamaica,  and  one  in  Rockaway  Beach,  will  be  needed.  In 
Richmond,  an  ambulance  station  on  the  southern  end  of  the  island 
will  probably  meet  the  needs  of  1920. 

On  Blackwell's  Island  to  meet  the  general  hospital  needs  of  the 
city,  as  well  as  to  provide  adequate  places  for  treatment  of  chronic 
and  convalescent  cases,  500  additional  beds  will  be  needed  at  the 
Metropolitan,  and  500  more  at  the  City  Hospital. 


CHAPTER  V. 

SUMMARY. 


To  bring  before  the  mind  of  the  reader  in  concise  form  the  con- 
clusions arrived  at  in  the  above  discussion,  Table  XIX  is  introduced, 
showing  the  present  hospital  needs  and  the  needs  in  Greater  New 
York  to  1920. 

Thus  for  the  whole  of  Greater  New  York,  for  present  needs  600 
beds  and  four  ambulance  stations  are  demanded.  For  the  needs  of 
the  city  to  1920,  we  conclude  that  eight  more  ambulance  stations  and 
2,800  additional  hospital  beds  will  be  needed,  making  in  all  for  the 
city  both  for  present  and  future  needs,  3,400  beds  and  twelve  am- 
bulance stations. 

Two  conclusions  stand  out  plainly  in  relief  in  this  summary.  The 
first  of  these  is  that  there  are  at  the  moment  urgent  present  needs  for 
additional  hospital  accommodations  in  certain  localities  of  the 
city,  which  demand  immediate  attention.  The  second  conclusion 
is  that  various  factors  lead  one  to  believe  that  within  fifteen  years 
additional  urgent  hospital  needs  will  be  pressing  upon  the  city. 
This  latter  need  demands  a  little  emphasis  in  the  summary.  It  is 
not  suggested  here  that  the  city  proceed  at  once  to  erect  hospitals 
in  every  locality  where  it  is  stated  that  there  will  be  need  of  one  in 
1920.  It  is,  however,  recommended  that  the  city  officials  use  the 
necessary  foresight  and  realize  the  coming  needs  for  additional  hos- 
pitals and  to-day  make  provision  for  these  future  needs.  By  this 
is  meant  more  specifically  that  hospital  sites  for  those  hospitals  not 
needed  at  once  should  be  purchased,  especially  in  the  outlying  sec- 
tions of  Brooklyn  and  Queens,  now  when  they  can  be  bought  for 
a  reasonable  sum  and  not  wait  until  fifteen  vears  from  now  when 


72 


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the  price  will  be  doubled  or  tripled.  Dr.  S.  S.  Goldwater,  Super- 
intendent of  the  Mt.  Sinai  Hospital,  in  an  address  before  the 
Medical  Society  of  the  County  of  New  York,  printed  in  the  New 
York  Medical  Journal  for  April,  1906,  arraigns  hospital  managers 
for  their  lack  of  foresight  in  not  securing  hospital  sites  in  the  out- 
lying sections  of  the  city  where  they  will  be  needed  without  doubt 
in  the  years  to  come.  He  says :  "  What  far-sighted  hospital  cor- 
poration is  there  that  will  take  steps  to  secure,  at  the  existing  low 
land  valuation,  desirable  hospital  sites  for  the  hospitals  which  the 
future  population  of  Queens  must  have?  None  that  I  know  of, 
and  probably  nobody  will  invest  a  dollar  in  the  reservation  of  a 
hospital  site  in  that  territory,  until  the  population  of  the  district 
has  increased  five-fold,  until  values  have  multiplied  and  until  the 
scandal  of  carrying  sick  people  many  weary  miles  to  the  hospitals 
of  Manhattan  and  Brooklyn  begins  to  weigh  heavily  on  the  public 
conscience."  This  statement  should  explain  what  immediate  action 
should  be  taken  with  reference  to  the  future  hospital  needs  of 
Greater  New  York. 

In  conclusion,  I  wish  to  acknowledge  my  indebtedness  to  Mr. 
Homer  Folks  and  other  members  of  the  Hospital  Committee  for 
their  many  timely  suggestions  in  this  investigation.  I  wish  also 
to  express  my  appreciation  for  the  aid  and  suggestions  given  me  by 
Miss  Lilian  Brandt,  Mr.  Frederick  Hoffman,  Mr.  Archibald  A.  Hill, 
Miss  Florence  L.  Lattimore,  Drs.  Hitchcock,  Jacobi,  and  Dana,  and 
for  the  uniform  courtesy  and  assistance  given  me  by  the  many  hos- 
pital superintendents  of  the  city. 

Respectfully  submitted, 

PHIL  P.  JACOBS. 


74 


APPEN 


TABLE  I— SHOWING  POPULATION  OF  MANHATTAN 
Population. 


Ward.  1880. 

1 17.939 

2 1 ,  608 

3 • 3.582 

4 20, 996 

5 iS,84S 

6 20, 196 

7 50, 066 

8 35,879 

9 54.596 

10 47,554 

11 66, 778 

12 81 ,800 

13 37,797 

14 30,171 

15 31,882 

16 52,188 

17 104,837 

18 66,611 

19 158, 191 

20 86, 051 

21 66,536 

22 in,  606 

Totals  for  Manhattan. . .  1 ,  206 ,  299 


1890. 

189S. 

1900. 

1905. 

II, 122 

12 , 508 

9,5i6 

io,595 

929 

1,038 

1,488 

673 

3,765 

4,OI4 

1,797 

3,  160 

17 , 809 

l8 , 404 

19,554 

22,793 

12,385 

IO , 603 

8,298 

7,871 

23.119 

22 , 897 

20, 004 

20,944 

57.366 

74,227 

89,237 

97.158 

31 . 220 

3L374 

29,059 

31. 117 

54,425 

60, 987 

59,65o 

60 ,  232 

57,596 

70,l68 

71,879 

67,149 

75,426 

86, 722 

99,144 

n6,333 

245,046 

364,412 

476 , 602 

594,856 

45,884 

58,802 

64,117 

58,304 

28 , O94 

31.904 

34,035 

34.485 

25,399 

26,216 

24, 066 

27.520 

49,134 

57,43o 

52,808 

58,558 

I03, 158 

144,727 

130,796 

149.324 

63,270 

67,469 

61,325 

67 ,622 

234,846 

267 , 076 

257.448 

283,455 

84.327 

94,969 

89,798 

87.342 

63 ,OI9 

72, 144 

60, 211 

7L738 

153,877 

194,893 
1,742,985 

189, 261 
1,850,093 

220, 692 

1,515,301 

+2, 091 , 921 

23  and  24. 


88,908 


POPULATION  OF 
125,075  200,507  271,630 


J  Health  Department  Census. 


POPULATION  OF  MAN 


Wards  1,2,3,  4,  5,6 70, 166  69, 129  69,464 

Wards  7,  10,  11,  13,  17 307, 022  339,  43  o  404,  626 

Wards  8,  9,  14,  15 152,528  139,138  150,481 

Wards  18  and  21 133,147  126,289  I39,6i3 

Wards  16  and  20 138,239  133,461  152,399 


60,657 
455,173 
146 , 810 
121,536 
142 , 606 


65 , 936 
488,268 
153,354 
139,360 
145,900 


DICES 


AND  THE  BRONX,  i? 


75 


5o-igos,  BY  WARDS. 
*Increase  per  Cent. 


Total. 


ti88o-i8go. 

1890- 

1900. 

1890— 1895. 

1895— 1900.     1 

900-1905. 

1880-1905 

.387 

.144 

•  137 

.239 

•  "3 

.409 

.422 

.  602 

.116 

•  433 

.547 

.581 

■  °Si 

.523 

.066 

.502 

.758 

.117 

.151 

.098 

■  °3S 

.  062 

.165 

.086 

.218 

.329 

.144 

.217 

.051 

.503 

.095 

.141 

.009 

.127 

.047 

.037 

-I4S 

555 

.294 

.  202 

.088 

.938 

.120 

.069 

.005 

.073 

.  071 

.132 

.003 

.  096 

.  121 

.022 

.011 

■  103 

.211 

.248 

.218 

.024 

.065 

.412 

.128 

•  314 

•  149 

.  164 

■  173 

•  742 

1-995 

.986 

.487 

.308 

.248 

6.  272 

■  2M 

•  395 

.281 

.091 

.091 

■  542 

.068 

.245 

■134 

.066 

.013 

.143 

.203 

055 

.  032 

.082 

■  143 

.136 

.058 

■  °75 

.  169 

.081 

.108 

.  122 

.016 

.268 

.112 

.  140 

.141 

.424 

.054 

.031 

.066 

.091 

.  102 

.016 

.484 

.  096 

.136 

.036 

.  IOI 

.792 

.020 

.065 

.112 

.054 

.027 

.015 

.053 

.044 

.161 

.165 

.191 

.078 

.378 

.  223 
.  229 

•  273 

.029 

.166 

•  977 

.  256 

.150 

.061 

.142 

•  751 

THE  BRONX  1890 

-1905 

1 

•  255 

.407 

.603 

•  354 

2. OSS 

HATTAN  BY  SECTIONS. 


.014 

.125 

.^05 

.131 

.087 

.060 

.105 

.341 

.191 

.125 

.072 

.590 

.087 

.  127 

.081 

.024 

.044 

.005 

.052 

.038 

.105 

.129 

.  146 

.046 

.035 

.068 

•  142 

.064 

.023 

.056 

*Black  face  type  denotes  decrease. 

tCensus  of  1895,  made  by  police  department,  is  of  little  comparative  value  on  account  of 
its  great  inaccuracy.     Comparisons  from  1890  to  1900  are  much  more  valuable. 


TABLE  II- 


Ward. 


-SHOWING  DENSITY  OF  POPULATION  AND  DEATH-RATE 
MANHATTAN,  1905,  BY  WARDS. 


Area  in  acres, 

excluding 

parks. 


1 I3I-57 

2 81. 

3 95- 

4 83. 

5 168. 

6 '  74-89 

7 186.65 

8 183. 

9 31987 

10 106. 

11 .■". 192.4 

12 4,719.58 

13 106.3 

14 96. 

IS 189.88 

16 349. 

17 320.49 

18 435-45 

19 1,317.76 

20 444. 

21 408.05 

22 1, 176.81 

Totals 11,184.7 


Population. 
1905. 

io.595 

673 
3,160 
22,793 
7,871 
20,944 
97-IS8 
31. "7 
60, 232 
67,149 

n6,333 

594,856 
58,304 
34,485 
27,520 
58,558 

149,324 
67,622 

283-,  4SS 
87,342 
71,738 

220, 692 


Number  of  Persons  per  Acre. 


1890. 

84.53 
11.47 
30.63 

214.57 
73-72 
297-73 
289.73 
170. 60 
170.15 
523.60 
384.83 
51-73 
428.82 
292.65 
I33-78 
140.79 
321.87 
145.30 
178. 21 
18993 
153-33 
129.95 


1900 . 

72.31 
18.37 
18 .  92 
235-59 
49-39 
267 . 11 
478. 10 
158.79 
186.48 
653-45 
515-3° 
100.95 
599-22 
354-53 
126.73 
151-31 
408. 10 
140.83 
195-37 
202 . 24 
146. 50 
160.83 


128.29     165.32 


1905. 

80. S3 
8.31 

32.26 
274.49 

46.86 
279.66 
520.53 
170 . 04 
188.31 
633-48 
604. 64 
126 .04 
549-39 
348.8o 
144-93 
167.78 
46S-92 
155-29 
215-13 
176.44 
I73-05 
196.88 

187.03 


IN 

Death- 
rate 
1905. 
46.8 
40. 1 

20.  6 
26.7 
36.2 
25. 
14.9 
17.8 
27.4 
14.6 
13-6 
16.  2 
12.8 
22 . 

21 . 
20.8 
15-4 
2S-7 

22 .  1 
24.1 
23-7 
20.  2 

18.2 


76 


TABLE  III— SHOWING  POPULATION 
Population. 


Ward  number. 
i 

2 

3 

4 

5 

6 

7 

8 

9 

io 

II 

13 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

3° 

31 

32 

Totals — Brooklyn 


1880. 

1890. 

1900. 

1905. 

18,729 

20,040 

20,327 

22,838 

9,254 

8,986 

8,565 

9,026 

18,271 

i8,754 

17,940 

19,484 

12 ,819 

12,324 

12,688 

12,951 

18,517 

20,175 

18,862 

19, 807 

35,437 

37,693 

42,485 

48,547 

31,663 

35,726 

40,471 

45,358 

17,388 

31,239 

52,414 

63,912 

15,044 

17 , 696 

42,876 

47,955 

27 , 140 

34,031 

39,100 

42,854 

21,680 

22,693 

22 ,608 

25,090 

,    '           22,201 

27,368 

30,354 

31,432 

21,029 

21,628 

24, 029 

23,567 

25,559 

27 , 246 

31,483 

33,298 

23,654 

27,630 

34,269 

32,982 

42,712 

45,720 

56,550 

61 ,  136 

30,088 

41,424 

57.309 

66,268 

23,926 

74,960 

25.133 

27,931 

27,661 

36,244 

37,645 

41,704 

24,188 

24,136 

35,446 

27,303 

3L956 

50, 118 

58,957 

65,176 

25,473 

50,250 

66,575 

74,974 

14,396 

29,348 

61,813 

67,966 

8,823 

16, 771 

31,767 

43,583 

19,055 

44,638 

48,328 

55,211 

29.505 

66,086 

94,149 

47,521 

.     87,303 

43.961 
77,912 

Included 

Included 

27,188 

43,o6l 

in 

m 

24, 700 

37,l63 

total. 

total. 

14, 609 

22,358 

8,243 

13,232 

599,495 

838,547 

1 ,  166,582 

1,358,686 

Ward  number. 

1 

2 

3 

4 

5 

Totals — Queens 


TABLE  IV— SHOWING  POPULATION 
Population. 


1880. 

1890. 

19 

00. 

IQ 

05. 

17, 

,  129 

30: 

,506 

48. 

,  272 

55 

,020 

9 

,804 

17 

.549 

40  : 

903 

60 

,559 

15. 

,  906 

19 

,803 

25, 

,870 

29 

,505 

10 

,088 

14 

.441 

30: 

,  761 

42 

,817 

t3. 

.632 
539 

U 

.751 

7, 

193 

9 

,926 

56, 

87, 

050 

152, 

999 

198, 

240 

Ward  number. 

1 

2 

3 

4 

5 

Totals — Richmond 


TABLE  V— SHOWING  POPULATION 
Population. 


1880. 

1890. 

1900. 

1905. 

12,679 

16,423 

21,441 

23,659 

9,029 

10,557 

13 , 200 

14,035 

7,014 

4,980 

5,289 

9,811 

6,644 

8.258 

13,701 
9,516 
9,163 

15,347 

9.480 
10, 198 

38,991 


t  Estimated  on  present  area  of  ward  by  U.  S.  Census. 


51,693 


67,021 


72,845 


77 


OF  BROOKLYN, 


50-1905,  BY  WARDS. 

*Increase  per  Cent. 


1880— 1890. 

1890— 1900. 

1900—1905. 

1880— 1900. 

1880-1905. 

1890— 1905. 

.070 

.013 

.139 

.085 

.  207 

•  144 

029 

.049 

.051 

.080 

.024 

,004 

.026 

.045 

.085 

.019 

.062 

.039 

.019 

.032 

.019 

.010 

■  058 

.082 

.069 

.050 

.018 

.069 

.018 

.063 

.  127 

•143 

.198 

.369 

.288 

.128 

.130 

.  121 

•  275 

.432 

.  269 

.796 

.678 

.  219 

2  .014 

2.675 

1.043 

.176 

1.428 

.  109 

1.850 

2. 161 

1.687 

.254 

.119 

.096. 

.441 

■  579 

•  259 

.047 

.004 

109 

.043 

.157 

•  105 

•  235 

.  109 

•  035 

•  367 

.866 

.148 

.028 

.  in 

.019 

.142 

.  121 

.089 

.066 

.144 

.058 

.232 

•  3°3 

.221 

.077 

.096 

.079 

•  237 

•  394 

.197 

.071 

•  237 

.081 

•  324 

•  431 

-341 

•  375 

.383 

.156 

■  9°5 

1.  202 

•  599 

2.133 

1.982 

.  in 

.051 

.  167 

.631 

•  310 

.038 

.108 

.361 

.508 

■  151 

.002 

•  °S4 

.052 

.052 

1.698 

•  131 

.568 

■  177 

.105 

.845 

I.039 

.301 

•  973 

•  324 

.  126 

1 .  610 

1.938 

•  492 

1.039 

1 .  106 

.  009 

3-3o6 

3-65I 

1. 316 

.901 

.894 

-353 

2.600 

3-939 

1-598 

1.342 

.082 

.142 

1.530 

J.897 

•  237 

1.239 

2. 191 

.081 

.121 
.584 
.504 
•  534 
.605 

.946 


.615 


OF  QUEENS,  1880-1905,  BY  WARDS. 


♦Increase  per  Cent. 


1880-1890. 

1890 

-1900. 

1900- 

-1903. 

1880— 1900. 

188c 

-1905. 

1890 

-1905. 

.781 

.582 

-139 

1. 821 

2.194 

.803 

.790 

1-343 

.480 

3-172 

5-177 

2.451 

.245 

.306 

.141 

.626 

.852 

.489 

.431 

1. 130 

•  392 

2.049 

3-244 

1.965 

.300 

•  514 

.241 

1 .  256 

1-733 

1 .089 

2.683 


OF  RICHMOND,  1880-1905.  BY  WARDS. 

♦Increase  per  Cent. 


188 

3—1890. 

1890— J 

900. 

1900- 

-1905. 

1900- 

-1905. 

1880- 

-1905. 

1890- 

-1905. 

.295 

•  305 

.103 

.691 

.866 

-441 

.169 

■  251 

.063 

461 

•  554 

■  329 

.256 

.396 

.  120 

953 

1. 189 

.564 

.334 

•  432 

.003 

911 

.903 

.425 

.561 

--.336 

.  109 

.112 

732 

■  932 
.868 

•  235 

.296 

.087 

.718 

.409 

*Black  face  type  denotes  decrease. 


78 


TABLE  VI— SHOWING  DENSITY  OF  POPULATION  AND  DEATH  RATE— BROOKLYN 

—BY  WARDS. 


Ward. 


13. 

14. 
15. 
16. 
17. 
18. 
19. 


23. 
24. 
25. 
26. 
27. 
28. 
29. 
3°. 
31- 
32. 


Area  in 
Acres. 

233. 
97-7 
161 .  4 
in. 3 

119. 4 
302.9 
458.  5 

1,843-2 
623.0 
318.7 
252.6 
663.1 
230.3 
282.6 
244.8 
244.8 
823.3 
873. 
413.8 

461. 5 
483.2 

1,361.6 
736. 

1,198.5 
567.8 

3.S90.2 
400.7 
884.4 

3,800. 

5,404-1 

6,312.3 

5,479-5 


Population. 


1800. 
20, 040 
8,986 
18,754 
12,324 
20,175 
37,693 
35,726 
31,239 
17 , 696 
34,031 
22 , 6g3 
27,368 
21,628 
27 , 246 
27,630 
45,720 
41,424 
74,96o 
30,244 
24,136 
50,118 
50,250 
29,348 
16,771 
44,638 
25,905 


Number  of  Persons 
per  Acre. 

1890.     1900.       1905. 


20,327 
8,565 
17,940 
12,688 
18,862 
42,485 
40,471 
52,414 
42,876 
39,100 
22 , 608 
30,354 
24, 029 
31,483 
34,269 
56,550 
57,309 
25,133 
37,645 
35,446 
58,957 
66,575 
61,813 
31,767 
48,328 
66,086 
43,961 
77,912 
27,188 
24, 700 
14,609 
8,243 


9 ,  026 
19,484 
12,951 
19, 807 
48,547 
45,358 
63,912 

47,955 
42,854 
25 ,090 
31,432 
23,567 
33,298 
32,982 
61,136 
66,268 
27,931 
41,704 
27,303 
65,176 
74,974 
67,966 
43,583 
55,211 
94, 149 
47,521 
87,303 
43,o6i 
37,i63 
22,358 
13,232 


86.0 

91.9 

116.  2 

no.  7 

168. .9 
124.4 

77-9 
16.  9 
28.3 

106.  7 
89.8 
41.3 
93-3 
96.5 

112  .9 


50.3 
85.5 
73-1 
52.3 
I03-7 
36.  I 
39-9 
13-9 


87.2 

87.7 

III .  2 

112 . 9 

158.0 

140.  2 

88.3 

28.4 

68.8 

122.7 

89.5 

45.8 

104.3 

in. 4 

123.6 

231.0 

69.6 

28.8 

91 .  o 

74-i 

122 . 

48.9 

84. 

26.5 

85.1 

18.4 

109.7 


97-9 
92.4 
120.  9 
116. 3 
165 . 9 
160.3 


34 

76 

134 

99 

47 

102 

117 


134.7 

249-3 
80.5 
31-9 

IOO.  7 
59-2 

134.9 
55-1 
92.3 
36.3 
97-2 

26.  2 

118. 5 
98.7 
11. 3 
6.87 
3-54 


1905 

Death 
Rate. 

16.4 

26.5 

13-7 

19.  6 

18.3 

28.2 

15-7 

16.5 

14-9 

19.  I 

29.4 

17-5 

23.7     - 

16.6 

16.5 

II. 4 

14-4 

31-3 

12.0 

25.2 


14.3 

24-3 
13  9 
12  .  1 
14-5 
14.  2 
45 -7§ 
13.6 
15-5 
10.5 


Totals — Brook- 
lyn       39,977-8 


1838,547      1,166,582      1.358,686        20. 


tPresent  area  of  borough. 

§The  presence  of  Kings  County  Hospital,  Home  for  Aged,   Contagious  Hospital,  and  several 
other  institutions  accounts  for  abnormally  high   death  rate. 

TABLE  VII— SHOWING  DENSITY  OF  POPULATION  AND  DEATH  RATE— QUEENS 

—BY  WARDS. 

1 4,650.  30,506  48,272  55,020  6.1  10.3  11. 8  18.7 

2 14,700.  17,549  40,903  60,559  1.2  2.7  4.12  13.4 

3 22,000.  19,803  25,870  29,505  0.9  1.1  1.34  10.6 

4 36,600.  14,441  30,761  42,817  0.39  0.81  1.17  16.6 

5 4,933-  *4,75I  7,193  9,926  0.97  1.4  2.10  15.2 

Totals — Queens    82,863  87,050         152,099  198,240         1.1  1.8         2.4     16.04 

*Estimated  on  present  area  of  ward,  by  U.  S.  census. 


TABLE  VIII— SHOWING  SUMMARY  OF  POPULATION  OF  GREATER  NEW  YORK- 
1880-1905— BY  BOROUGHS. 

Population.  Increase  per  Cent. 

Name  of 


Borough. 


1890. 


1900. 


1905- 


Manhattan 1,206,299  1,515,301  1,850,093  2,091,921 

The  Bronx 88,908  200,507  271,630 

Brooklyn 599,495  838,547  1,166,582  1,358,686 

Queens 56,539  87,050  152,999  198,240 

Richmond 38,991  51,693  67,021  72,845 

Totals — Greater 

New  York. . .    1,901,324  2,580,599  3,437,202  4,014,187 


1880 

1890 

1900 

1880 

to 

to 

to 

to 

1890. 

1900. 

1905- 

1905. 

.256 

.  229 

.142 

■751 

1-255 

•354 

2.055 

•399 

•  391 

.161 

1259 

•  539 

•  757 

.289 

2.683 

■  326 

.  296 

.087 

.868 

.362 


.332     .168     I. Ill 


79 


TABLE  IX— SHOWING  HOSPITAL  POPULATION  OF  MANHATTAN  AND  THE  BRONX 


9- 


German  Hospital,  77th 
street  and  Parle  avenue. 

Hahnemann  ?Iospital,  68th 
street  and  Park  avenue. 

Flower  Hospital,  63d  street 
and  Avenue  A. 

French  Benevolent  Hos- 
pital, 450-58  W.  34th 
street,  between  gth  and 
10th  avenues. 


258 


Name  and  Address  of  Hos- 
pitals in  Order  of  Wards 

in  which  Located. 
Ward 

number. 

4.  St.  Gregory's  Hospital,  03 

Gold  Street, near  Frank- 
fort. 

5.  House  of  Relief,   63   Hud- 

son, corner  Jay. 
5.  Trinity  Hospital,   50  Var- 

ick  street,  near  Canal. 
7.  Gouverneur  Hospital,  Gov- 

verneur    Slip    and    East 

River. 
7.  Beth  Israel  Hospital,  Jef- 
ferson, corner  Cherry. 
St.      Vincent's      Hospital, 

nth    and    12th    streets 

and  7th  avenue. 
St.  Francis  Home,  609  5th 

street,  near  Avenue  B. 


Mt.     Sinai     Hospital,     100        291 
101st     street,     Madison 
and  Fifth  avenues. 

Sydenham   Hospital,   339—  30 

341  E.  116th  street,  near 
1st  avenue. 

St.  Luke's  Hospital,  113th        190 
street    and    Amsterdam 


12.  J.  Hood  Wright  Memorial 
Hospital,  131st  street 
and  Amsterdam  avenue. 

12.  Washington  Heights  Hos- 
pital. 554  W.  165th 
street. 

12.  Harlem  Hospital,  136th 
street  and  Lenox  ave.    • 


Philanthropin      Hospital 
Fifth  ave..   and    128th 

street. 
St.    Mark's    Hospital,    177 

2d  avenue,  near  nth  St. 
New  York  Hospital,  15  and 

1 6th  street,  between  5th 

and  6th  avenues. 
New     York     Postgraduate 

Hospital,  2d  Avenue  and 

20th  street. 
Columbus  Hospital,  226  E. 

20th  street,  between  3d 

avenue  and  Gramercy 

Park. 
Presbyterian  Hospital, 70th 

street  and  Madison  Ave. 


Number  of  Patients. 


Jan.  1,  Sept.  1 
1905.       1905. 


Mar.  1 
1906. 


67 
165 


65 


176 


196 


65 


83 


87 


49 
170 


*37 


387 


362  335 

20  37 

207  213 

43  37 

439  35 


65 
190 

161 


Number 

of    beds, 

Mar.  1, 

1906. 


Remarks. 


20  Hospital  opened  Jan.  1,  1905. 
Bed  capacity  Dec.  1,  1907 
was  40  beds. 

35  Census  estimated  on  first  two 
dates. 

28  Hospital  closed  Aug.  31 
1907. 

90  Remodelled  hospital  now  ac- 
commodates 160. 

120  Some  additions  to  bed  ca- 
pacity recently  made. 

380  New  wing  of  125  beds  re- 
cently opened. 

275   Closed  as  a  general  hospital. 
Receives      chronic    cases 
only. 
480  35  beds  of  the  480  are  kept 
constantly   in    reserve   for 
emergency    and    isolation 
cases. 
65   New  hospital  for  200  beds  to 
be  started  somewhere  near 
present  one  soon. 
261   Have  plans  to  enlarge  to  ca- 
pacity of  600,  but  nothing 
definite  as  to    time.      Bed 
capacity   on    Dec.    1,  1907 
was  298. 
58  Expect  to  build  hospital  of 
200  beds.. 

40  Bed  capacity  Jan.  20  1908 
was  23.  Will  build  a  new 
hospital  soon. 
553  New  hospital  at  136th  street 
and  Lenox  avenue  now 
open   with   150  beds. 


79  Will  add  6  beds  during  1908. 

205  Plans  for  10  more  private 

rooms. 

216  Hope  to  build  adjoining  an 
addition  for  150  beds. 

125   New  addition  on  19th  street 
recently  completed. 


214  Top  floor  with  100  beds 
closed  for  lack  of  funds. 
Proper  capacity,  315. 


160 

203 

245 

40 
62 
76 

57' 
72 

76 

81   Has  large  number  of  private 

patients. 
100  An  addition  for  80  beds  con- 
templated. 
150 

1Census  on  April  25,  1906 

2Housecleaning  and  renovating  made  low  census. 

3Carried  forward  from  Jan.  1,  1905. 

4Census  on  Jan.  1,  1906.     Hospital  Sept.  1,-1905. 

5Bed  capacity  includes  9  cribs  for  infants. 

9  Census  January  1,  1908.     Hospital  moved  from  Williambridge. 


8o 


TABLE  IX— SHOWING   HOSPITAL  POPULATION  OF   MANHATTAN   AND  THE 

BRONX — Continued. 


Number  of  Patients. 


755 
72 


8161 


Name  and  Address  of  Hos 

pitals  in  Order  of  Wards      . ■ — 

in  which  Located.  Jan.  1,  Sept.  1, 

Ward  1905.     1805, 

number. 
2i.   Bellevue     Hospital,     26th 

street  and  East  River 
31.  New  York  Polyclinic  Hos- 
pital, 214—20  E.  34th 
street,  between  2d  and 
3d  avenues. 
22.  Roosevelt  Hospital,  58th 
and  59th  streets,  9th  and 
10th  avenues. 

22.  St.     Elizabeth's    Hospital, 

415  W.  51st  street,  be- 
tween 9th  and  iothAves. 
13.  Lebanon  Hospital,  E.  150th 
street  and  Cauldwell 
avenue. 

23.  St.  Francis  Hospital,  i42d 

street,  St.  Ann's  and 
Brook  avenues. 

23.  Lincoln        Hospital        and 

Home,  E.  141st  street, 
Concord  avenue  and 
Southern  Boulevard. 

24.  Fordham  Hospital,  Croton 

avenue  near  Pelham 
avenue. 

Totals     (excluding    Black- 


Mar.  1, 
1906. 


811 

66 


171 


60 


145 


400 


43 


40 


123 


377 


5o 


'69 

215 
60 
165 

9I25 

10478 
61 


Number 

of  beds, 

Mar.  1, 

1906. 


Remarks. 


6980  "Greater    Bellevue"    to    ac- 
commodate 2,000. 
96  Bed  capacity  on  Dec.  1,  1907 
was  105. 

244  Bed  capacity  on  Dec.  1,  1907 
was  337. 

65   Takes  private  patients  only. 


205   Bed  capacity  on  Jan.  20,  1908 
was  230. 

500  New  hospital  for  acute  cases 
opened  March  15,  1906. 


500  About 
cases. 


are    not   hospital 


56  New  hospital  Southern  Boule- 
vard and  Croton  avenue, 
near  Pelham  avenue,  now 
open  with  150  beds. 


well's  Island  hospitals) .    4,065        4,049        4,651 


BLACKWELL'S  ISLAND  HOSPITALS. 

City  Hospital,    Southern    end       700  645  654  689  Had  bed  capacity  of  705  on 

BlackweH's  Island Oct.  1,  1907. 

Metropolitan  Hospital, 
Northern  end  Blackwell's 
Island 12S97       124^4        125gi  533   Had  612  beds  onOct.  1, 1907. 

Totals — Manhattan,   Bronx 

and     Blackwell's    Island 

Hospitals 5.362       5,158       5,901        7,202 

6Bed  capacity  reduced  by  about  100,  because  of  work  on  new  pavilions. 

'Census  has  reached  since  Mar.  1  as  high  as  90.     Most  of  cases  are  surgical. 

8Housecleaning  and  renovating  made  low  census.     On  Nov.  1,  had  219. 

9Census  January  1,  1908.     Hospital  moved  from  Williamsbridge. 

10Most  of  cases  (about  75  per  cent.)  are  chronic.  Hospital  acts  as  relief  for  City  Home  for 
Aged  and  Infirm.  v 

nThe  new  Mt.  Moriah  hospital  now  being  built  at  138-140  2nd  street  will  accommodate  about 
40  patients. 

"Census  and  bed  capacity  excludes  tuberculosis.     Bed  capacity  Oct.  1,  1905. 


8i 


TABLE  X— SHOWING  HOSPITAL  POPULATION  OP  BROOKLYN. 


Names  and  Addresses  of    Number  op  Patients. 

Hospitals  in  Order  of    . ■ 

Ward  in  which  Jan  i,  Sept.  i,    Mar.  i, 

Ward  Located.  i9°5-      1905.        1906. 

number. 

6.  Long  Island  College  Hos- 
pital, corner  Henry,  Pa- 
cific and  Amity  streets. 

6.  St.  Peter's  Hospital,  Henry 
street,  between  Congress 
and  Warren. 

8.  Norwegian  Lutheran  Dea- 
coness Home  and  Hos- 
pital, corner  46th  street 
and  4th  avenue  (Bay 
Ridge). 

8.  Samaritan    Hospital,    cor- 

ner 4th  avenue  and  17th 
street. 

9.  The  Jewish   Hospital,  cor. 

Classon  and   St,   Marks 
avenues. 


Number 

of  beds, 

Mar.  1, 

1906. 


Remarks 


166 


250 


45 


11.  The  Brooklyn  Hospital, 
corner  Raymond  street 
and  De  Kalb  avenue. 

13.  Brooklyn  E.   D.   Hospital, 
106  S.  Third  street,  be- 
tween Bedford  avenue 
and  Berry  street. 

13.  Williamsburgh    Hospital, 
corner  Bedford   avenue, 
and  S.  Third  street. 

18.  St.  Catherine's  Hospital, 
Bushwick,  Ten  Eyck 
and  Maujer  streets. 

20.  Cumberland  street  Hospi- 
tal, Cumberland  street, 
near  Myrtle  avenue. 

22.  Methodist  Episcopal  Hos- 
pital, 7th  avenue  and 
6th  street. 

24.   St.  John's  Hospital,  corner 

Atlantic      and      Albany 

avenues. 
24.   St.  Mary's  Hospital,  corner 

St.  Marks  and  Rochester 

avenues. 

24.  Swedish    Hospital,    corner 

Sterling  Place  and  Rog- 
ers avenue. 

25.  Bushwick  Hospital,   How- 

ard avenue  and  Monroe 
street,  near  Broadway. 

26.  Bradford   Street  Hospital, 

109  Bradford  street,  near 
Atlantic  avenue. 

26.  Lutheran  Hospital,  New 
York  avenue,  between 
Powell  and  Junius 
streets. 

28.  German  Hospital  of  Brook- 
lyn, St.  Nicholas  av- 
enue and  Stockholm  St. 

28.  Bethany    Deaconess    Hos- 

pital, St.  Nicholas  av- 
enue and  Bleecker  street. 

29.  Kings     County     Hospital, 

Clarkson  street  and  Al- 
bany avenue. 
31.  Coney     Island     Reception 
Hospital,    Surf    avenue, 
near     Ocean     avenue, 
Coney  Island. 


107 


185 


651 


164 


252 


66 


113 


198 


203 


238 


75 


139 

34 

58 
164 

205 
70 

73 


36 


S85 


250  New  hospital,  replacing  old 
one,  to  hold,  when  finished 
37S  beds. 

321  Over  30  per  cent,  of  work  is 
for  consumptives. 

94 


12   Plans  now  ready  to   double 
capacity  within  few  months. 

Hospital     opened     in    Dec. 

1906,  and       had      bed 
capacity  of  160  on  Dec.  1, 

1907,  with  83  patients. 
165   Bed  capacity  on  Dec.  1, 1907. 

was  175. 

38   Will   add   40  beds   within  a 
year. 


196  Wing  of  7s  beds  used  for 
convent  to  be  fitted  for 
hospital  purposes. 


100  When  all  additions  in  pro- 
gress and  contemplated 
are  completed,  hospital 
will   accommodate   200. 


230  Expect   to   add    50   beds   in 
near  future. 

50  Opened  July  1,  1906.  for 
patients.  Had  census  of 
32,  on  Dec.  1,  1907. 

38  Hope  within  5  years  to  build 
hospital  of  100  beds  in 
Bushwick. 
8  Plans  now  ready  for  new 
hospital  nearby  of  about 
100  beds. 

54  Expect  to  build  new  hospital 
of  80  beds  within  2  years, 
but  not  decided  as  to  lo- 
cation. 
120  Will  add  another  wing  of  100 
beds  soon. 

35 


631  Census     omits     neurological 
cases  and  121  neurological 
beds. 
8   New   hospital   of   about   100 
beds  to  be  built  nearby 


Total — 21  hospitals 2,045        1,983       2,241       2,719 


2Census  June  1,  hospital  opened  March  7,  1906. 
4Serves  as  receiving  station  for  Kings  County  Hospit 


'Census  Jan.  1,  1906. 

3Census  Sept.  30.  ^Serves  as  receiving  station  for  Kings  County  Hospital. 

'Hospital  usually  open  only  6  months  of  year,  April  to  Oct.  Hospital  open  all  winter  in  1908. 


TABLE  XI— SHOWING   HOSPITAL  POPULATION  OF  QUEENS. 


Number  of  Patients 


Names  and  Addresses  of 

Hospitals  in  Order 

of  Ward  in  which        Jan.  i,    Sept.  i,    Mar.  i, 
Ward  Located.  i9°5-      i9°5-        1906. 

number. 


1.   St.   John's   Hospital   corner        139 
Jackson  and  12th  streets, 
Long  Island  City. 


3.  Flushing  Hospital,  Parsons 

and     Forest     avenues, 
Flushing,    L.  I. 

4.  St.    Mary's    Hospital,    Ray 

and  Shelton  avenues,  Ja- 
maica. 

4.  Jamaica       Hospital,       New- 

York  avenue,  near  Atlan- 
tic, Jamaica. 

5.  St.  Joseph's  Hospital,  Cen- 

tral avenue,  near  Lock- 
wood  street,  Far  Rocka- 
way. 


Totals — Queens  (5  hospitals)      242 


130 


Number 

of  beds 

Mar.  1, 

1906. 

;         147 


Remarks. 


New  wing  of  125  beds  in 
course  of  erection.  Pres- 
ent bed  capacity  slightly 
reduced  by  building  oper- 
ations. 


35 

36 

32 

60 

37 

41 

52 

72 

31 

26 

29 

70 

hs 

39 

40  Will  build  addition  soon,  but 
can  not  tell  how  large  or 
when. 

'Hospital  opened  June  25,  1905. 


TABLE  XII— SHOWING  HOSPITAL  POPULATION,  RICHMOND. 


Names  and  Addresses  of  Number  of  Patients.     Number 
Hospitals  in  Order  of    - 
Ward  in  Which 
Ward  Located. 

number. 

1.  S.  R.  Smith  Infirmary,  Cas- 
tleton  avenue,  New  Brigh- 
ton, Staten  Island. 
1.  St.  Vincent's  Hospital,  West 
New  Brighton,  Staten 
Island. 

Totals — Richmond  (2  hospitals)      124 


Jan.  1,  Sept.  1,  Mar.  1, 

Mar.  1, 

1905.      1905-         1906. 

1906. 

79              75              96 

161 

45              46              63 

70 

Remarks. 


70  This    hospital    has    also    80 
beds  for  consumptives. 


§3 


TABLE  XX. 
SHOWING  KNOWN  ADDITIONS  TO  BED  CAPACITY  UP  TO  1920,   BY  HOSPITALS. 

MANHATTAN. 

Names  of  Hospitals      Bed  Capacity    Additions      Known  bed  Remarks 

in  Jan.  1,  1908       definitely  capacity 

Alphabetical  order  known  (beds)*      in  1920 

Bellevue 1050  950  2  ,  000  Two  pavilions  of  new  hospi- 

tal will  be  opened  in  1908. 

Beth   Israel 146  4  150  Expect    to_  build    entirely 

new  hospital. 

Flower 100  80  180  _ 

French  Benevolent.  ..  .  115  35  150  Has     accommodations     for 

150. 

German 234  7  241  Isolation  ward  to  be  added. 

Harlem.  .  .' 120  30  150  Can    accommodate    150. 

Mount  Moriah ....  ....  40  In  building. 

New  York 207  10  217  Additions  to  be  in  private 

rooms. 

Presbyterian 225  100  325  100  beds  closed  for  lack  of 

funds. 

Red  Cross 52  3°  82 

St.  Luke's 298  68  366         Will    eventually   have    600 

beds. 

St.   Mark's 89  6  95 

St.  Vincent's 400  25  425         May   add   more   beds   but 

not  known. 

Sydenham 85  115  200         Site  purchased  for  new 

hospital. 

Totals  Manhattan..  4.858  1,460  6,318 

(all  hospitals) 

BLACKWELL'S  ISLAND. 
Metropolitan 612  150  762  Capacity  and  additions  ex- 

clude Tuberculosis  Infir- 
mary. 
City 705  200  905 

Totals  Blackwell's 

Island 1,317  35o  1,667 

*  Hospitals  to  which  no  additions  are  to  be  made  are  omitted.     Only  definitely  known 
additions  are  considered. 


TABLE  XXI. 
SHOWING  KNOWN  ADDITIONS  TO  BED  CAPACITY  UP  TO  1920,  BY  HOSPITALS. 

BROOKLYN. 

Names  of  Hospitals      Bed  capacity       Known      Bed  capacity 

in  Jan.  1,  1908    additions  up        in  1920  Remarks 

Alphabetical  order  -to  i92o(beds)* 

Bradford  Street 8  92  100  City  will  build  new  hospital. 

Brooklyn  E.   D 37  43  80  Work   will   be    commenced 

this  year. 

Bushwick 39  61  100  Will  build  new  hospital. 

Coney  Island 8  92  100  New  hospital  to  be  erected 

by  city. 

Cumberland  Street.  .  .  .  200  80  280 

German 122  100  222 

Kings  County 591  200  791  Improvements  at  new  an- 

nex building  will  give  in- 
crease. 

Long  Is.  College 200  12s  32s  Additions  in  building. 

Methodist._ 150  50  •        200 

St.  Catherine's 190  50  240 

St.  Mary's 230  25  255 

Totals  for  Brooklyn 
(all  hospitals)     ..  2,882  918  3,800 

QUEENS. 
St.  John's 150  12s  375  New  wing  soon  to  be  opened 

Total    for    Queens 

(all  hospitals) .. .  395  ■  125  520 

*  Hospitals  to  which  no   additions  are  to  be  made  are  omitted.     Only  definitely  known 
additions  are  considered. 


j    V        of  fn£         *   7 


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